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Chest Radiology Interactive Teaching Session

Chest Radiology Interactive Teaching Session. Nevzat KARABULUT, M.D. Pamukkale University Hospital nkarabulut@yahoo.com. Case 1. 76-year-old female Bronkorhea Loss of apetite, weight loss (10 kg in 5 months). 76- year - old female. Which dx is the most unlikely?

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Chest Radiology Interactive Teaching Session

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  1. ChestRadiologyInteractiveTeachingSession Nevzat KARABULUT, M.D. Pamukkale University Hospital nkarabulut@yahoo.com

  2. Case 1 • 76-year-old female • Bronkorhea • Loss of apetite, weight loss (10 kg in 5 months)

  3. 76-year-oldfemale Which dx is the most unlikely? • Diffuse pneumonia • Pulmonary alveolar proteinosis • Cryptogenic organizing pneumonia • Tumor • Hypersensitivity pneumonitis

  4. 76-year-oldfemale

  5. Which of thefollowingsignsarepresent on CT? • CT Angiogram • Crazy paving • Halo sign • 1+2 • 1+2+3

  6. Which of thefollowingsignsarepresent on CT? • CT Angiogram • Crazy paving • Halo sign • 1+2 • 1+2+3

  7. What is your final diagnosis? • Diffuse pneumonia • Pulmonary alveolar proteinosis • Cryptogenic organizing pneumonia • Bronchioloalveolar cell carcinoma • Diffuse alveolar damage

  8. MucinousBronchioloalveolarcellcarcinoma

  9. Bronchioloalveolar cell carcinoma • Subgroup of adenocarcinoma • 5% of all bronchogenic carcinomas • Mucinous (20-30%) and Clara cell or type II pneumocyte • Can be seen as • Single or multiple nodules • single or multiple consolidation (more common in mucinous tumors)

  10. Consolidative BAC • CT findings that suggest BAC rather than pneumonia • non-resolving peripheral consolidative pneumonia with associated nodules • stretching, squeezing and widening of the branching angle of bronchus within consolidation • Bulging of the interlobar fissure • multiple cysts or bubble like radiolucencies Jung JI. Br J Radiol 2001; 74:490-494

  11. CTangiogramsign • Presence of >3 cm pulmonary vessel within a consolidation • Initially described for lobar form of BAC • 92% specificity • Pneumonia • Pulmonary edema • Obstructive pneumonitis • Lymphoma • Mets from GI carcinomas

  12. Crazypavingpattern • Interlobular septal thickening superimposed on ground glass opacity • Initially described for PAP • Bronchiloloalveolar cell carcinoma • Exogeneous lipoid pneumonitis • Infections

  13. Alveolar proteinosis Pneumocystis jiroveci pneumonitis

  14. CASE 2 • 49-year-old male • Chest pain and cough • CABG operation 5 years ago

  15. 49-year-old male

  16. What is the most likely diagnosis? Foreign body Lung cancer Hamartoma Solitary fibrous tumor

  17. Gossypiboma • Hx of surgery • Low-density inhomogeneous mass with hyperdense capsule • Whirling hyperdense lines Topal U. Intrathoracic gossypiboma. AJR 2001 177:1485-1486.

  18. Incomplete bordersign • Partial obscuration of border of extrapulmonary lesions where it is not surrounded by air • Analogy with Sillhoutte sign • Extrapleural fat • Solitary fibrous tumor of pleura • Rib lesions

  19. 64 y-male, RLLobectomy 3 monthsago

  20. 50 y-female, CABG

  21. CASE 3 45-year-old asymptomatic female with abnormal CXR

  22. A) Central mass @ RLL B) Atelectasis of RLL C) Vascular abnormality D) RML disease E) Kartagener syndrome

  23. AVM • Atelectasis of RLL • Abnormal pulmonary venous return • Swyer James Syndrome • Kartagener’s syndrome

  24. Scimitarsign

  25. ScimitarsignHypogenetic Lung syndrome • Small Right hemithorax • Retrocardiac or paracardiac tubular density • Abnormal vein: • IVC • PV, HV, Right atrium • 25% associated with CHD • ASD, VSD, PDA

  26. Therecognition of signsandpatterns on CXR and CT is helpfulforaccuratediagnosis

  27. Case 4: 25-year-oldman, smoking (+)Cough, bloodysputum, milddispnea

  28. What is yourpresumptivediagnosis? • Mass • Interstitial thickening • Cystic lung disease • 3+1 • 4+1

  29. What is your final diagnosis? • Fungus ball in tuberculosis cavity • Fungus ball in Lymphangioleiomyomatosis • Fungus ball in Langerhans cell histiocytosis • Cystic and solid metastases • Invasive aspergillosis in cystic lung disease

  30. Fungus ball in Langerhans cell histiocytosis

  31. Aspergilloma (mycetoma) • Colonization of a preexisting lung cavity by saprophytic fungi (Aspergillusspp) • Preexisting lung cavity • TB • Sarcoidosis • Bronchiectasis • Fungusball: fungus, cellulardebris, fibrin, andinflammatorycells • Thickandvascularwall: hemoptysis

  32. LCH LAM

  33. Case 5: 59-year-oldfemalewithdrymouth

  34. 59-year-oldfemalewithdrymouth What is your diagnosis? • Lymphangioleiomyomatosis • Langerhans cell histiocytosis • Lymphoid interstitial pneumonia • Centrilobular emphysema • Birt Hogg Dubé syndrome

  35. LIP (Sjögren syndrome)25% of cases

  36. Thank you for your attention and participation nkarabulut@yahoo.com

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