Langerhans cell histiocytosis

Case contributed by Dr Ahmed Abdrabou

Presentation

Heavy smoker came with sudden onset of chest pain and dyspnea.

Patient Data

Age: 30 years
Gender: Male
X-ray

Moderate right-sided pneumothorax. A small nodular opacity is noted at right upper zone.

Both lungs show multiple scattered small thin walled irregular cysts as well as small irregular shaped nodules with an upper lobe predilection and sparing the costophrenic angles.

Moderate right pneumothorax. 

Case Discussion

The combination of cysts and nodules in a male smoker is suggestive of Langerhans cell histiocytosis. Pathologically, smoking works as an antigen which stimulates histiocytes proliferation at terminal bronchioles forming nodules which later cavitate.

The patient underwent a lung biopsy which confirmed the diagnosis. 

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