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Pulmonary Langerhans cell histiocytosis

Case contributed by Kashif Nadeem Liaqat
Diagnosis almost certain

Presentation

History of ongoing lung disease, now presented with acute breathlessness.

Patient Data

Age: 20 years
Gender: Male

There is bilateral diffuse generalized severe cystic changes with associated reticulonodular shadowing. Right sided surgical emphysema and pneumothorax seen. Chest drain also noted.

Diffuse bilateral, nearly symmetrical reticulonodular opacities with innumerable air cysts ranging in size from 1 to 3 cm, involving almost the entire lung fields but relatively sparing the extreme bases of the lungs. The lung volumes are not decreased. There is evidence of residual right pneumothorax, surgical emphysema and minimal pneumomediastinum, with right intercostal chest tube. There is evidence of right sided minimal pulmonary effusion as well. No significant bony abnormality in visualized images.

IMPRESSION
Features of pulmonary LCH (known case) complicated by right sided pneumothorax and surgical emphysema.

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