Aspergillomas in Preexisting Cavities

• Sarcoidosis reached this end stage because it was untreated in earlier stages • Hemoptysis in a patient with end-stage sarcoidosis strongly suggests that the infiltrate in the left upper lobe is an aspergilloma • In this situation, left upper lobe process should be aspergilloma(s)...

Gallstone Pleurolithiasis

• Surgeons estimate that stones are lost in up to one-third of cases ∘ They are not necessarily aware that stones are lost ∘ Not usually dictated in note ∘ They do not attempt to retrieve ∘ 〉100,000 laparoscopic cholecystectomies done each year • Do not spontaneously dissolve...

Chyloptysis

• 73-year-old woman • Nonsmoker • 5 episodes in 2 years of acute-onset dyspnea on exertion, orthopnea, productive cough of peculiar-tasting sputum • Knew of no precipitating factors • Low-grade fever • Bibasilar crackles • CXR ∘ Migratory with different events that lasted 2 to 6 days...

Carney Triad

1. Pulmonary chondroma 2. Gastrointestinal stromal tumor (GIST), formerly, gastric epithelioid leiomyosarcoma 3. Functioning extra-adrenal paraganglioma • Triad eventually present in more than half of patients • 〉90% of patients are female • Mean age: 17 years • Mechanism: unknown (disease absent in 1 identical twin)...

Erdheim-Chester Disease

• Disease of bone with bilateral symmetric sclerosis of metadiaphyseal region of long bone ∘ 35% of patients have lytic lesions • Bone pain in 35% of patients despite nearly 100% bone involvement • Lungs affected in 35% of patients • Multiple organs can be involved—liver, skin, brain, heart or pericardium with infiltration of lipid-laden foamy histiocytes (? variant of histiocytosis X)...

Epithelioid Hemangioendothelioma (EH)

EH is being presented along with intravascular lymphomatosis (IVL) because it is frequently confused with IVL. But, EH is not a lymphocytic disorder • Other terms for the condition ∘ Intravascular bronchiolar tumor ∘ Intravascular lymphomatosis • Symptoms ∘ Dyspnea ∘ Cough ∘ Rarely, hemoptysis...

Pulmonary Infections

• Dog heartworm—Dirofilaria immitis • Canine dirofilariasis reported from every state • Humans are end-stage host • Asymptomatic to nonspecific symptoms • 83-year-old man • Smoker • Mild dyspnea on exertion • CXR 11 months previously did not show SPN, in retrospect • No clubbing...

Ochronosis

• Metabolic disorder of deforming arthropathy • Homogentisic acid in urine, which becomes dark on standing and is characteristic • May be first diagnosed on lateral CXR • Eventually pigmentation of skin, sclerae, and ear and nose cartilage • Earliest change is laminated calcification of intervertebral disk, followed by collapse of disk spaces and osteoporosis. Osteophytes are a later occurrence, as is involvement of weight-bearing joints...

Rheumatoid Nodule

• Rheumatoid nodule is prone to pneumothorax • Commonly associated with rheumatoid effusion (bilateral in CXR on next slide) • Effusion is uncommonly associated with pleurisy (unlike systemic lupus erythematosus) • Rarely massive • Rheumatoid effusion with very low or even 0 mg/dL glucose; fluid clear with only a few polymorphonuclear leukocytes...

Pharyngoesophageal Diverticulum

• Also known as Zenker diverticulum • Note aspiration pneumonitis at bases • Need to be cautious because esophagoscope can perforate diverticulum if you do not know about it and do not know where you are