Presentation
Known case of connective tissue disease. Complaining of gradual onset of progressive dyspnea.
Patient Data
Low lung volume.
Bilateral ground glass nodules and small cysts. Mild interstitial lung changes.
Low lung volume.
Low lung volume.
Low lung volume.
Axillary and medistinal lymphadenopathy. Scattered bilateral small thin wall cysts and ground glass nodules. Some of the nodules demonstrates cystic degeneration at the interval. Mild interstitial lung changes.
Case Discussion
The patient known case of MCTD, SLE, Sjogren syndrome.
This case demonstrates interval degeneration of multiple pre-existing ground glass nodules into emphysematous cysts with millimeter thick walls. Interval growth of the pre-existing bilateral pulmonary cysts. Interval development of new bilateral scattered ground glass nodules and interval development of non-specific irregular solid subpleural nodule in the left lower lobe. Grossly unchanged bilateral axillary and mediatinal lymphadenopathy. Among the differential diagnostic considerations one should consider Wegener's granulomatosis and lymphocytic interstitial pneumonitis. If the patient is immunocompromised, PCP and fungal pneumonia should be considered. Finally, lymphoproliferative disorders and cystic metastases to the lung parenchyma should be excluded.
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