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 septal (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