Case #93: The man with shortness of breath
This is the chest radiograph of a young man with HIV. He complains of progressively worsening shortness of breath of 3 weeks duration with occasional low grade fever. On examination, he is tachypnoeic, afebrile, and auscultation of the lungs reveals occasional scattered crepitations. His oxygen saturation on room air is 72%.
Questions:
1. Describe the abnormality in the film.
2. What is the most likely diagnosis?
Mon, 091109 @ 0700
Categories: Patient of the Week, Xray of the Week
Honeycomb appearance of the middle zones bilaterally.
Dx: Interstitial lung disease (which could be due to Pneumocystis Carinii Pneumonia)
Bilateral perihilar nodular hazziness with an opacity at the right hilar region. (?calcified old TB or lymph node)
Most likely pneumocystis jiroveci infection with the past history of HIV, SOB, and shortness of breath. Differential diagnosis is miliary TB because HIV & TB are good friends.
there are many things in this film
1_ bilateral hilar congestion, and cystic changes
, plus a round mass at the r. hilar area ,
2_erosion of the 3rd & especially the 4th r.side ribs
3_radiolocuent round area over the left 3rd rib…
4_ hyper inflated chest
so DD
1_always keep in mind the possibilty of pcp in such patients
2_ fungal mass ( aspergelioma)
3_ but how to explain the abnormal R. ribs???