Answer to yesterday's puzzle

35 year old, non smoker male , presents with exertional dyspnoea -for last 2 years, progressive.

Discuss the differential diagnosis?

?14 year old girl ,fever ,weight loss ,loss of appetite 2 months.

how will you proceed from here?

LUL fibrocavitary infiltrates. ESR,TT,Sputum AFB -3 days ,get the basics right.

What is the most dominent radiological pattern in this HRCT ?

What is the likely diagnosis ? Would you recommend a lung biopsy to this person ?

Dominent pattern is ground glass opacification.With interstitial ,reticular patttern,some subpleural fibrosis and early honeycombing.

Ground glassing indicates active disease and not an advanced fibrosis.this is considered drug treatable. Lung biopsy is indicated.

Incidentally this was the first thoracoscopic lung biospy I did .Histopathology - NSIP

56 year old , non smoker male , ? asbestos exposure in past, ongoing left lower chest pain , fever and some dyspnoea -last 6 months. Pleural tap from left sided collection -pus ,grown pseudomonas.Biopsies done CT guided -necrotic material .

55 year old male , presents with 6 weeks history of cough and high grade intermittent fever,There is no weight loss.This man has smoked 3.5 packs/day for last 30 years.

Please describe the findings on this X ray image.

Read all abnormalities

65 year old male presents with dysphagia and chest pain .What are the abnormalities in this CT image ?

Both lung bases show patchy consolidation ,the other striking finding is penumomediastinum

Is the seed sown?

20 year old female patient with cough ,fever, weight loss - 1 month.

What is the radiological pattern? What is the most likely diagnosis ?

Answer - This is 'tree in bud' pattern - It suggests endobroncial spread of disease process.Most likely diagnosis -tuberculosis.

(Incidentally this is confirmed tuberculosis with BAL PCR positive and AFB culture from BAL sample growing M.tuberculosis)

Identify this radiological pattern ?

This is a straightforward one. Can you tell why this is not ground glass opacification ?

Answer - Pattern is consolidation .In a consolidation you can't appreciate the vessels.In a ground glass opacification vessels are still visible.

Identify the radiological pattern ?

This is a 47 year old male with progressive exertional dyspnoea - over 1 year. He had moderate restriction on spirometry and Baseline SaO2 of 92 uio% o room air.There is no clubbing.

What is this pattern ? what is the DD ? How will you confirm the diagnosis?

Answer - Mosaic pattern. DD for this ranges from hypersensitivity pneumonia to alveolar proteinosis to IPF. Lung biopsy is the method to confirm the diagnosis.

Incidentally this was usual interstitial pneumonia (UIP-IPF) on histopathology.