Imaging Quiz

10/22/13

Case Scenario 1
A 41 year old male with no significant !" #resents to out#atient #ulmonary clinic for a$normal imaging% atient had a recent &'I and had #resented to urgent care% C(' was ta)en and re#orted as a$normal% *n +uestioning he com#laints of occasional chest tightness% ,enies any e-#osures. li/ed in 0altimore all his life. denies any tra/el. weight loss. rashes. fe/er. chills or loss of a##etite% 1or)s at a des) 2o$% 34 unremar)a$le. una$le to do a fundosco#ic e-am

,escri$e the C(' findings 1hat would $e the differential diagnosis $ased on imaging5 State any manifestations of this disease which if #resent you would treat the a$o/e #atient who is asym#tomatic%

6his C(' shows no good #enetration is in mild ins#iration7#t has not inhaled to full ins#iration8 Costo#hrenic angles are seen without any e/idence of effusion% 6he dia#hragm is not flattened% "eart is within normal limits79:0; of width of chest8% erihilar consolidations are noted $ilaterally with mild interstitial #ulmonary /ascular mar)ings% Aortic )nuc)le is seen with no a$normalities% 6rachea is intact and not de/iated% <o e/idence of lo$ular congestion or #neumonia% ,,(4 1% Sarcoid 2% 60 3% =ym#homa 4% 0ronchogenic ca :% !ets

Case Scenario 2
A >0 yr old male who wor)ed as a sand$laster #resents with #rogressi/e dys#nea% "e is also a smo)er. li/es in a rural area and has not seen a #hysician in many years% "e is currently una$le to e/en do his A,=?s without S*0% 1hat does the C(' show% *ne of the findings is also seen in other conditions% <ame 1%

C(' is

not on full ins#iration% ,ensities are seen on the e-ternal #art of the u##er lo$e% 6here are #erihilar egg shell calcifications that are #rominently seen on the C('% Calcifications seem to surround the lym#h nodes% Costo#hrenic angles not seen% t is a sand$laster that is /ery inidicati/e of the diagnosis at hand%6he heart is less than :0; of the side of the chest ca/ity% ,,(4 Silicosis. Scleroderma. Amyloid de#osition. histo#lasmosis. #ost irradiated hodg)ins lym#homa% Criteria for 3gg Shell Calcification4 Calcification 92mm thic) in the #eri#hery of a lym#h node 'ing@li)e shadow must $e com#lete in at least one of the nodes in/ol/ed *ne of the nodes must $e at least 1 cm in size 6here may or may not $e interior calcifications