A 40-year-old patient s/p allogeneic stem cell transplant for AML 6 months prior presents with progressive dyspnea. The exam is unrevealing and imaging is obtained.
The patient’s CT reveals mosaic attenuation. Mosiac attenuation is a pattern of scattered regions of the lung with differing densities. The abnormal portions can be those that appear white or black.
Tip: Inspiratory and expiratory films can help identify the cause!
The patient had PFTs that showed severe obstruction, and significant change from PFTs prior to the stem cell transplant. Inspiratory and expiratory CT confirmed significant areas of gas trapping. She was diagnosed with bronchiolitis obliterans secondary to chronic GVHD
This week’s #RadiologyRounds is brought to you by our newest contributor, Nick Ghionni! We’ll dive into a classic Radiology Sign and talk about what it represents, and how it helps inform your differential.
In this case, the patient underwent a biopsy that showed no malignancy but grew NTM! Given that NTM can be superimposed on malignancy, repeated biopsies were done that corroborated. She is being treated with close monitoring.
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.
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?
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.
This week’s #RadiologyRounds and tutorial is authored by Huzaifah Salat, our newest PulmPEEPs contributor! See if you can figure out the case and check out our high-yield points at the end. Follow us on Twitter to answer live polls about the case.
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.
It is Tuesday and time for another #RadiologyRounds!! This is a patient who presented to the emergency department with symptoms of cough, dyspnea, malaise, and weight loss. A PA and lateral CXR was obtained.