Pulmonary Langerhans cell histiocytosis
Generalised weakness and dyspnoea. Smoker.
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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.
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.