Getting a film with Kerley lines in the exam is one of the many exam set-pieces that can be prepared for.
The film goes up and after a couple of seconds pause, you need to start talking:
There are bilateral basal interstitial lines that extend to the pleural surface - these are Kerley B lines. There is slight asymmetry of the breast shadows and metallic clips in the right axilla. Features are consistent with previous breast carcinoma and lymphangitis carcinomatosis.
I would compare this with previous films and confirm the presumed diagnosis of treated breast carcinoma. The bone appears normal and there is no evidence of a pericardial effusion (both of which may occur with metastatic breast carcinoma).
While there are many causes of septal lines, consider a shorter differential in the examination:
- Kerley lines plus
- remember to mention the other signs of pulmonary oedema where they exist: alveolar oedema, pleural effusion, cardiomegaly
- discussion of interstitial lung patterns is fraught with difficulty so prepare well