Pulmonary Langerhans cell histiocytosis

Case contributed by Dr Hazem Mohammed

Presentation

Generalized weakness and dyspnea. Smoker.

Patient Data

Age: 30 years
Gender: Male

There are a bilateral almost-symmetrical reticulonodular pattern opacities and cystic lesions with more predilection for mid and upper zones. 
The costophrenic recesses, anterior right middle lobe and lingula are spared. The cysts are heterogeneous, some of which show cavitation.
There is a lytic lesion involving the neck of the 5th left rib.

Case Discussion

Pulmonary Langerhans cell histiocytosis commonly affects young adult smokers. History, clinical symptoms and imaging findings are the key to diagnosis.

The imaging findings show a specific distribution of reticulonodular pattern opacities and cystic lesions as seen in this case. However definitive diagnosis is made by lung biopsy.

In this case, the presence of a lytic bony lesion supports the diagnosis of pulmonary Langerhans cell histiocytosis.

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