Wednesday, August 2, 2017

Subpleural opacities and Ground Glass Opacities

Hey guys!

I saw a patient today, a 37 year old female patient with chief complaints of cough and shortness of breath. She has a history of allergic rhinitis and migraine. She is also obese with an BMI of 31.

As you must have guessed already she was diagnosed with Bronchial asthma. On the spirometry report done 4 months back,  there was an obstructive pattern and after giving bronchodilators her FEV1 increased by 22% (>12%) and FEV1 vol increased by 300ml (>200ml). These findings also strongly support the diagnosis of asthma.

She was started on Albuterol as needed and Salmeterol-fluticasone MDI. She didn't show good response in the first 4 weeks, so she was also started on Montelukast and Tiotropium inhaler.

Now after 4 months, she still had cough and shortness of breath. She had bilateral polyphonic wheezes. A chest X Ray was done which came out to be normal. On pulse oximetry, SaO2 was 97% while breathing ambient air. On chest CT we found two attributes:
Subpleural opacities and Ground glass opacities.

So based on the CT scan findings, differential diagnosis:

Subpleural opacities:
1. Eosinophilic granulomatosis with polyangiitis( previously called Churg Strauss).

2. Organizing pneumonia

3. Pulmonary embolism with resultant subpleural pulmonary infarction

4. Allergic bronchopulmonary aspergillosis ( well, not really, actually in this case, there is peripheral air space opacification which looks identical to subpleural opacities)

Now Ground glass opacities:

1. Atypical pneumonia

2. Hypersensitivity pneumonia

3. Several ILDs

4. Sarcoidosis

5. Pulm Edema

6. Pulm Haemorrhage

That's all!

-VM

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