Pulmonary Langerhans cell histiocytosis, a nodular and eventually cystic lung disease of the upper and mid lung zones
, is a disorder of cells with Langerhans cell phenotype.
HP: poorly defined centrilobularmicronodules, widespread ground-glass opacities, mosaic attenuation and air trapping with a predominance of disease in upper and middle lung zones
under appropriate clinical setting.12
A chest X-ray revealed extensive ill-defined bilateral parenchymal opacities in the perihilar, mid, and lower lung zones
Systemic sclerosis-ILD is typically a nonspecific interstitial pneumonia (NSIP) pattern with groundglass opacities, interstitial pulmonary fibrosis, and honeycomb cystic changes in the lower lung zones
[5, 6, 23].
PLCH shares it cystic pathogenesis with usual interstitial pneumonia which is distinguished by clustered distribution of its cysts preponderant in the lower lung zones
The patient also had decreased breath sounds in both lower lung zones
and moderate pitting edema up to the knees.
In the case of emphysema, there is often apical predominant destruction of lung tissue, confining edema in a regional distribution to the lower lung zones
.(4) Reticular patterns of edema, radiographically indicated by the presence of Kerley A and Kerley B lines, have also been described as occurring with increasing frequency in the presence of emphysema.(5) This is attributed to impairment of lymphatic flow in the chronically diseased lung with decreased compliance and elasticity, resulting in stasis and engorgement of the lymphatic network even in the absence of significantly elevated pulmonary venous pressures.
Furthermore, PLCH predominates in the upper and mid lung zones
, a feature common in many smoking-related lung diseases.
Her lung examination revealed crackles in mid lung zones
Breath sounds were diminished in left lung zones
. Percussion revealed dullness in the same regions.
Numerous small pulmonary nodules in the peripheral lung zones
of the lower lobes suggested pulmonary metastases.