Presentation
Smoker.
Patient Data
Multiple small thin-walled pulmonary cysts scattered within the upper lobes, right middle lobe, and superior segments of the lower lobes. There are a few scattered small solid pulmonary nodules. Biapical pleural parenchymal band of scarring. The airways are normal. The pleural spaces are clear.
There is no lymphadenopathy. Surgical clips in the anterior mediastinum, no discrete masses. The imaged superior abdomen is unremarkable, a small hepatic cyst is unchanged. No suspicious osseous lesions.
Case Discussion
This patient has been followed-up in the respiratory clinics due to her pulmonary Langerhans cell histiocytosis. This is a late follow-up scan in where, different from centrilobular emphysema, the features are those of lung cysts with discrete thin walls. Although present, the nodules are not a distinct finding on this scan but were seen in her old imaging (not shown). The longterm and current smoking history with lung cysts in a predilection for the mid and upper zones make LCH the most likely diagnosis on imaging.
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