Mnemonics for Radiologists and FRCR 2B Viva Preparation A systematic approach Ebook PDF download
Mnemonics for Radiologists and FRCR 2B Viva Preparation A systematic approach Ebook PDF download There are two different themes to a film showing bilateral upper lobe fibrosis. One will
be an “Aunt Minnie”, with a giveaway additional feature such as that described (e.g. a portacath – an implanted venous access device). The other will require a good description of the findings, the provision of a sensible list of differential diagnoses (such as sarcoidosis, TB and pneumoconiosis) and a good management plan.
Pneumoconiosis is due to the accumulation of inhaled dust particles in the lung. Silicosis and coal worker’s pneumoconiosis are the two best-known forms.
Pneumoconiosis may either be simple (resulting in multiple small lung nodules) or complicated (resulting in PMF, which is seen bilaterally in the upper lobes).
It is difficult to distinguish between sarcoidosis, TB and pneumoconiosis on a single chest radiograph. However, some findings are more common in one or more of these conditions than in others.
Mediastinal lymphadenopathy is more common in sarcoidosis than secondary
Cavitating lung lesions are more frequently a feature of reactivation TB.
Conglomerate perihilar upper lobe masses larger than 1 cm are more often seen in PMF.
Peripheral “egg-shell” calcification of hilar lymph nodes is most commonly seen in silicosis but is also seen in coal worker’s pneumoconiosis and sarcoidosis.
Background nodularity of the lung parenchyma can be seen in any of these
Pearls Is the case an “Aunt Minnie”? Look at the lower cervical spine. Is there an unusual non-anatomical pattern of fibrosis? Is there a portacath in a young patient? On a radiograph showing bilateral upper lobe fibrosis without any specific distinguishing features, sarcoidosis, TB and complicated pneumoconiosis/PMF are the three most sensible possible diagnoses.
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