Hypoxia in an elderly male

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Recently, there was a chest conference pertaining to the CT in Langerhan’s cell histiocytosis. 

This 81 year old male presented to the emergency room with severe hypoxia.  He had been a long-time smoker, and had been short of breath over the last year.  A CT scan was done and images are below. 

Do you think the CT scan is most compatible with 1) emphysema 2) idiopathic pulmonary fibrosis 3)pulmonary fibrosis with emphysema 4) end-stage langerhan’s cell histiocytosis 5) end stage sarcoidosis?

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2 Responses to Hypoxia in an elderly male

  1. SNG says:

    Sure looks like a lot of thin walled cysts predominantly in the mid- to upper-lung zones. I bet a biopsy would show peribronchiolar nodules with variable fibrosis and honeycomb-like structures. There are newer stains that have been described in the past few years that would be interesting to use on lung tissue such as this (e.g. anti-CD103 antibodies, see Sung et al. J Immunol 176:2161, 2006).

  2. rochesterlunggroup says:

    This is most characteristic of end-stage Langerhan’s histiocytosis

    M Kallay

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