Imaging of the weekDr.Anirudh J Shetty
PROF.DR.DHANDAPANI’S UNIT
34 yr old unmarried male ,c/o fever without chills –2 days; breathlessness & hemoptysis-1 day;h/o non productive cough +No h/o haematuriaNo h/o chest pain /PND /orthopneaNot a known DM/HT/TB/IHD/BA/ pt.
O/E emaciated,thin ,dyspneic,tachypneic vitals-BP -110/80 mmHg CVS-S1 ,S2 heard RS- bil.BB + in
infrascapular,mammary ,inframammary and infraaxillary areas bil.creps.+
other systems- NAD
SUMMARY; -CHEST X RAY PA VIEW -ADEQUATELY PENETRATED -INSPIRATORY FILM -PROPERLY CENTRED -TRACHEA IN THE MIDLINE -SOFT TISSUES & BONE NORMAL -HEART SHADOWS NORMAL
NON HOMOGENOUS OPACITIES SEEN BILATERALLY IN THE MID AND LOWER ZONES
MORE ON THE LEFT SIDE
DIFFERENTIAL DIAGNOSIS; ACUTE ALVEOLAR LUNG DISEASE
“HEAP” Hemorrhage -Wegener granulomatosis
Systemic lupus erythematosus Goodpasture syndrome Other vasculitides (e.g., polyarteritis
nodosa, Henoch-Schönlein purpura)
Edema Alveolar proteinosis/Aspiration Pneumonia (includes infectious, organizing, and eosinophilic pneumonias)
Pneumocystis PNEUMONIA RADIOLOGY; - bilateral diffuse opacities, perihilar
initially,with a lower zone predominance”ground glass “opacities
-later air space consolidation pattern
ATYPICAL PRESENTATIONS -solitary/multiple ;solid /cavitory nodular opacities -cystic lung disease -enlarged noncalcified/calcifiedhilar/mediastinal nodes -pleural effusion -air filled cysts/pneumatoceles causing pneumothorax
CLINICAL FEATURES; non specific
dyspnea,dry cough
minimal signs –few crackles,wheeze
unusual-asthma,hemoptysis,HPOA
PCP related pneumothorax-sudden dyspnea in AIDS patients
EXTRAPULMONARY PCP; Virtually every organ system can be
affected heart thyroid bonemarrow brain git skin other manifestations include otitis media
and externa, sinusitis n splenomegaly
Thank u