Pulmonary Langerhans cell histiocytosis

Case contributed by Dr Laughlin Dawes

Presentation

This 41 year-old male has respiratory failure and is awaiting a lung transplant. He presented with an infective exacerbation of his disease.

Patient Data

Age: 40
Gender: Male

The plain frontal chest x-ray shows mild hyperinflation, and a coarse pattern in the lung fields consisting of reticular interstitial markings and peripheral ring shadows suggesting cysts.

Case Discussion

High resolution CT confirmed the presence of multiple small peripheral cystic lesions, some of which were branching and bizarre. There was honeycombing in the lower zones. There were a few small peribronchovascular nodules and there was interlobular septal thickening. The differential diagnosis of multiple pulmonary cystic lesions includes Langerhans cell histiocytosis, lymphangiomyomatosis, sarcoidosis and lymphocytic interstitial pneumonitis. Peripheral bronchiectasis should be considered as it may appear cystic. Given the other changes seen on HRCT, and the patient’s sex, LCH was the favoured imaging diagnosis.

Image contributed by: Dr Laughlin Dawes

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Case information

rID: 35847
Case created: 24th Apr 2015
Last edited: 2nd Apr 2017
System: Chest
Inclusion in quiz mode: Included

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