Lady with Dyspnoea and Cough

Saturday, February 20, 2010
This is a PA chest Xray of a 43 year old  woman who was presented with Shortness of Breath on exertion(Dyspnoea), Cough and Chest pain.Other than the pulmonary symptoms she also complains of milld fever and loss of appetite.

Respiratory Examination was normal other than bilateral crackles.


Comment  on her Chest Xray?
What are the Differntial Diagnosis?

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25 comments

  1. Anonymous Says:
  2. classic presentation of PTB!

     
  3. Anonymous Says:
  4. bronchopneumonia

     
  5. Anonymous Says:
  6. Its PTB.

     
  7. Anonymous Says:
  8. IPF fits. hard to see miliary shadowing if its TB

     
  9. Anonymous Says:
  10. arash from iran


    there is reticular pattern in lung with some degree of ground glass appearance
    sarcoidosis

    occupational lung disease
    pulmonary fibrosis
    interestitial lung diseases
    hypersensitivity pneumonitis

    there is more tendency to involve basilar part of lung than apical region so we can narrow differential diagnosis to
    1-hypersensitivity pneumonitis
    2-BOOP
    3-alveolar proteinosis but in this disease we see alveolar pattern with air bronchogram not riticular one

    please send it to your memory , diseases can cause apical infiltration more than basilar involvement:

    1-silicosis
    2-berylliosis
    3-RA
    4-sarcoid
    5-PLCH
    6-ankylosis spondylitis
    i make a code of it , i attach starting letters of these disorder to make
    SIB-RAS-PAN

     
  11. a Says:
  12. Galala

    pneumonia with special consideration of H1N1 viral infection

     
  13. Anonymous Says:
  14. I THINK MAY BE IT IS INTERSTITIAL LUNG FIBROSIS

     
  15. Anonymous Says:
  16. interstital lung disease

     
  17. Anonymous Says:
  18. i think miliary TB

     
  19. Anonymous Says:
  20. neumonia basal, por los infiltrados en las bases....

     
  21. Anonymous Says:
  22. atipical pneumonia... maybe m. pneumonia

     
  23. Admin Says:
  24. Answer for this case is stage 3 sarcoidosis.(lung infiltration - reticular pattern in the basilar and apical parts without hilar lymphoadenopathy)
    Most of you said Intestitial lung disease as your DD.I agree that its difficult to come to a defenetive Dx with a short Hx and Xray alone...
    DD list intestitial lung disease(...broad category),milliary TB,Acute pulmonary Odeama(but we can easily exclude it in this case).

     
  25. Ameen Zubair Says:
  26. Interstitial lung fibrosis

     
  27. Anonymous Says:
  28. sarcoidosis

     
  29. Anonymous Says:
  30. CXR show miliary shadowing of both lung fields

    D/D;interstitial lung disease,& milliary TB


    dr sadia

     
  31. go block Says:
  32. from this foto we can see the pattern of bronchus is increasing in both sides and there is no sign of cardio megaly and if the history of fever exist it means that its an infection process which is specific or non specific... from this pts history there are fever and loss of apetite so --> pnemonia from specific process suspicious from TB with DD lobar pnemonia or bronchitis chronic state...

     
  33. SHERIF MONIB Says:
  34. My DD iclude
    Pulmonary fibrosis
    Interestitial lung diseases

     
  35. Anonymous Says:
  36. so??
    i think all D.D. mentioned.
    what is the DIAGNOSIS

     
  37. DD Says:
  38. i think sarcoidosis dd/silicosis, with milliary TB

     
  39. Anonymous Says:
  40. bronchopneumonia

     
  41. Anonymous Says:
  42. ithink it's miliary TB and the differential diagnose is Bronkopneumonia

     
  43. kenny Says:
  44. miliary Tb - COPD

     
  45. Anonymous Says:
  46. Sarcoidosis

     
  47. Anonymous Says:
  48. Interstizial lung disease

     
  49. miliary Tb & DD with INTERSTITIAL LUNG FIBROSIS

     

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