Getting a film with Kerley lines in the exam is one of the many exam set-pieces that can be prepared for.
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Radiographic features
Plain radiograph
There are bilateral basal interstitial lines that extend to the pleural surface - these are septal (Kerley B) lines. There is slight asymmetry of the breast shadows and metallic clips in the right axilla. Features are consistent with previous breast carcinoma and lymphangitis carcinomatosis.
I would compare this with previous films and confirm the presumed diagnosis of treated breast carcinoma. The bone appears normal and there is no evidence of a pericardial effusion (both of which may occur with metastatic breast carcinoma).
Differential diagnosis
While there are many causes of septal lines, consider a shorter differential in the examination:
Practical points
- Kerley lines plus
- mastectomy or axillary clips - think lymphangitis carcinomatosis
- large heart - think cardiogenic pulmonary edema
- normal sized heart - think non-cardiogenic pulmonary edema
- remember to mention the other signs of pulmonary edema where they exist: alveolar edema, pleural effusion, cardiomegaly
- discussion of interstitial lung patterns is fraught with difficulty so prepare well
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