We ask: what is the diagnosis?

RADIOLOGICAL DIAGNOSIS

We ask: what is the diagnosis?

57 year old Caucasian man

Weakness and dyspnea to moderate effort for two years, with 20 kg weight loss during this period

Smoker for 15 years, 1/3 of a pack per day. Quit smoking four years ago.

Jorge Kavakama^I; Nestor Müller^II

^IRadiologist of the Imaging Diagnosis of the Heart Institute – InCor of the HCFMUSP, São Paulo, SP

^IISt. Paul’s Hospital, Vancouver, BC, Canada

The purpose of this section is to stimulate the clinical reasoning from radiological data. We would like the whole community to participate by sending your diagnostic to the e-mail [e-mail] (do not forget to identify yourself; the right answers will be announced). These are the most important images of the case, which may be seen with further details in jornaldepneumologia.com.br. CHECK THE DIAGNOSIS IN THE NEXT ISSUE.

Diagnosis of the case of the previous issue

J Pneumol 2003;29(2):116

Lymphocytic Interstitial Pneumonia (LIP)

HIGH RESOLUTION CT (HRCT)

Predominant damage of the lower pulmonary fields, characterized by: opacity in dim glass, cystic formations, ill-defined center-lobular nodes, small sub-pleural nodes, and septal thickening.

Comments

LIP is considered a benign lymphoproliferative disease, characterized by diffuse interstitial infiltration, with predominance of lymphocytes and plasma cells.

It is usually associated with other diseases, especially Sjögren’s Disease and AIDS. Other associations include primary biliar cirrhosis, multicentric Castleman’s disease, chronic active hepatitis, renal tubular acidosis, miastenia gravis, systemic lupus erythematosus, auto-immune thyroiditis, and bone marrow allogeinic transplant.

It generally affects adults in their 50´s, predominantly women, except in the case of AIDS, in which the damage is higher for children.

At the thoracic X-ray, the most frequent aspect is the reticular or reticular-nodular pattern, damaging the lower fields. Further alterations include bilateral consolidation, nodules and hilar lymphonodusmegaly, the latter being more usual in AIDS.

At HRCT, the predominant alterations are bilateral opacity on dim glass and ill-defined center-lobular nodes. Other findings: cysts, sub-pleural nodes, thickening of the peribronchovascular interstice and of the interlobular septum. More seldom: nodes of 1 to 2 cm in diameter, consolidation of the airway, bronchiectasis and faveolating.

In the Sjögren’s Syndrome the predominant findings of LIP at the HRCT are opacities on dim glass and cysts.

Benedito Francisco Cabral Junior – Brasília University Hospital (HUB) Brasília, DF

José Antonio Baddini Martinez –Ribeirão Preto School of Medicine (USP), Ribeirão Preto, SP

Karina Tavares Oliveira – Escola Paulista de Medicina (EPM), São Paulo, SP

Lucia Ande Santos – Universidade Federal de São Paulo, São Paulo, SP

Marcelo Alcântara Holanda – Universidade Federal do Ceará, Fortaleza, CE

Marcelo Bicalho de Fuccio – Escola Paulista de Medicina, Universidade Federal de São Paulo, (EPM/UNIFESP), São Paulo, SP

Marcelo Coelho Machado –Itamaraty Medical Center, Vitória da Conquista, BA

Marlon B.M. Molina – HAGF, Ponte Nova, MG

Nassir José Jabour Khoury –Albert Sabin Hospital, Juiz de Fora, MG

Richard Volpato –Heliópolis Hospital, São Paulo, SP

Roberto Rodrigues Junior –ABC School of Medicine, São Paulo, SP

Simone Castelo Branco Fortaleza –Messejana Hospital, Fortaleza, CE

Publication Dates

• Publication in this collection
  24 Sept 2003
• Date of issue
  June 2003