Presentation
Fevers for 4 months.
Patient Data
There is esophageal distension and a gastric band is noted. The mediastinum is otherwise unremarkable. Pleural spaces are clear.
Disseminated nodules, predominantly centrilobular, are present in the right lung segments.
There left lung shows a small number of nodules in the left lower lobe.
There are no changes of ground glass opacification, no features to suggest interstitial fibrosis.
The changes are most likely due to recurrent aspiration and an infectious bronchiolitis.
Case Discussion
The patient has no known history of collagen vascular disease. She admits sleeping almost exclusively on her right side. These imaging changes are most likely due to recurrent aspiration and an infectious bronchiolitis.
Centrilobular nodules are 5-10 mm nodules lying centrally within the pulmonary lobule.
They are encountered in infectious bronchiolitis, where they maybe unilateral or bilateral. They are also seen in subacute hypersensitivity pneumonitis, RB-ILD, and pulmonary Langerhans cell histiocytosis.
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