Radiology Rounds – 10/25/22

This week’s #RadiologyRounds is coming from the pulmonary clinic. Follow us on Twitter to see the case and answer our polls live!

Given the patient’s weight loss and persistent symptoms despite trying some empiric therapies, a chest CT was obtained. PFTs were also ordered 🙂

The patient’s CT had tree-in-bud opacities, nodular consolidations, scattered micronodular opacities, and airway thickening.

The pt had an induced sputum but could not produce a sample. She underwent bronchoscopy + lavage and her AFB smear was positive with negative TB NAAT. The culture ended up growing M. chimaera! Does that explain her symptoms? Here are the diagnostic criteria for pulmonary NTM:

All other testing was negative and the patient was diagnosed with pulmonary NTM. After a long discussion about treatment (an interesting topic for another day!!) she was started on triple antibiotic therapy and after 9 months her cough had resolved and she was gaining weight.

Radiology Rounds – 10/11/22

For #RadiologyRounds this week we have a mystery case from the pulmonary clinic complete with imaging and exploration of PFTs. Follow along for some great clinical pearls and teaching points about lung function tests. Graphics made with the help of outstanding educator Kaitlin Seitz.

What imaging views would you get next?

A) Supine and prone

B) Inspiratory and expiratory

C) High resolution

D) With contrast

What test would you get next?

A) Bronchoscopy



D) Lung US

What do these PFTs show?

A) Restriction concerning for ILD

B) Restriction concerning for obesity

C) Restriction concerning for weakness

D) Mixed obstruction and restriction

The patient was referred to neurology and ultimately diagnosed with severe mixed sensory and motor chronic axonal polyneuropathy.

Radiology Rounds – 8/30/22

Time for another #RadiologyRounds! This case is authored by PulmPEEPs associate editor @TessLitchman. Great teaching ahead!

Trick question (sorry)! All of these features are present.

A bronchoscopy was performed and the patient was diagnosed with PCP. Additional testing confirmed a new diagnosis of HIV.

This patient was treated with high-dose Bactrim and IV steroids, in addition to being started on ART.

Radiology Rounds – 8/16/22

It is Tuesday and we have another Radiology Rounds we can’t wait to share with you. Follow along and see if you select the right answer as we go through different presentations of sarcoidosis and pick your answer! What stage is it?!

A middle-aged man presents to you after he was found to have hilar adenopathy on a routine chest x-ray.

A middle-age man presents with dyspnea on exertion, night sweats and weight loss. You see evidence of bilateral apical disease, and fibrosis with evidence of honeycombing on chest CT.

A young woman presents with dyspnea on exertion and was found to have hilar adenopathy with parenchymal disease.

An elderly man presents with dyspnea on exertion and was found to have nodular parenchymal disease without extensive lymphadenopathy.

Radiology Rounds – 7/12/22

Time for another #RadiologyRounds!! This week we’re looking at the coronal CT scan views, which can be extremely helpful and are often under-utilized. Follow us on Twitter to work through Radiology Rounds cases as they come out.

Our patient had an elevated VEGF-D level, a renal angiomyolipoma identified on CT abdomen, and imaging with diffuse cystic lung disease confirming her diagnosis of LAM. Make sure to check out the ICUOnePager made by Dr. Nick Mark.

Radiology Rounds – 6/14/22

This week on #RadiologyRounds we are extremely excited to share a case brought to you by one of our new Associate Editors, Leon Mirson! Enjoy, and follow us on Twitter and Instagram for content delivered to you weekly!

What abnormalities do you see on this CXR to help explain the patient’s presentation?

The CT scan has reticular changes consistent with interstitial lung disease and there are multiple features that help us define the pattern of the ILD. His CT notably has very few ground-glass opacities, there is traction bronchiectasis, and honeycombing with a basilar and peripheral / sub-pleural predominance.

Taking all these features together, the patient’s radiographic presentation is consistent with Usual Interstitial Pneumonia (UIP)

This patient had a thorough history taken and he had no prior smoking and no occupational or environmental exposures of significance. He had no family history of interstitial lung disease. A broad history was taken regarding symptoms of connective tissue disease and a broad serologic workup was sent, all of which were unremarkable. What would you want to do next diagnostically?

If you want to learn more about diagnosing interstitial lung disease, listen to our prior Top Consults episode on diagnosing ILD with experts in the field and see these prior #RadiologyRounds on Fibrotic NSIP and Sarcoidosis.