The particularity of this case was that each lung had a different imaging spectrum:
Right lung shows an hyperlucent lung due to chronic obstructive pulmonary disease -COPD- and centrilobular emphysema. Left uppel lobe lung shows a classical "honeycomb" pattern with variable size cysts and thickened septa.
Could this be a part of one single entity?
When lungs are affected with COPD, usually emphysema occurs. In the other hand, honeycombing appeareance is always and end-stage pulmonary disease and is formed by fibrosis and loss of pulmonary volume with trapped air cysts.
Differentials of focal cystic lung disease include:
- Pulmonary Langerhan´s cell histiocytosis
- Lymphangiomatosis
- Sarcoidosis
- Lymphocytic intesticial pneumonitis (LIP)
- Pulmonary mesenchymal cystic hamartoma (rare)
- Asbestosis
- Idiopatic pulmonary fibrosis
- Cystic fibrosis
Usually these pathologies are supleural in location, with multiple variable in size cysts but with small thickened septa. Other differential is also a bullous emphysema but septa is not thick as well.
Also, most of all pathologies tend to present as a bilateral setting, making the diagnosis of this case more difficult.
This patient didn't underwent biopsy, he refused so was treated as Focal idiopatic pulmonary fibrosis and was recommended to discard Cystic fibrosis.
Hope this review was helpful. Even though case is incomplete, we can approach to diagnosis through these differentials.
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