🫁 Challenging chest CT pattern 41-year-old male. Chronic kidney disease secondary to polycystic kidney disease CT findings: ▫️ Innumerable miliary nodules ▫️ Bronchial interlobular septal thickening ▫️ Isolated mediastinal lymphadenopathy ▫️ No pulmonary edema 📌 With no additional clinical information, applying a pattern-based approach, the main differentials are: 1️⃣ Miliary tuberculosis 2️⃣ Hypersensitivity pneumonitis 3️⃣ Sarcoidosis #RadTwitter #RadRes #ChestImaging #MedEd

To answer the question in this post, HRCT readers should be aware of two things. First, they need to understand the features of smoking-related interstitial fibrosis (SRIF). SRIF manifests in three main appearances: 1.Involvement of existing centrilobular and paraseptal emphysema by developing dense, definable walls and causing irregular, heterogeneous shapes and sizes, thereby disfiguring their usual appearance. 2.Cysts within reticulation. 3.Large irregular cysts. It’s important to note that the second and third appearances do not abut the pleura. SRIF typically occurs without other fibrotic features such as traction bronchiectasis, bronchiolectasis, irregular reticulation, or honeycombing. The second question to address is whether SRIF contributes to combined pulmonary fibrosis and emphysema (CPFE). The answer depends on the presence of fibrotic features such as traction bronchiectasis, bronchiolectasis, irregular reticulation, or honeycombing. If these features are present, SRIF is not the contributor to CPFE. Based on these guidelines, you can determine which of the four cases are CPFE due to SRIF.

Pseudocirrhosis! Findings of liver cirrhosis, but in the setting of hepatic mets. Most common after chemo treatment of breast cancer 🟡Volume loss 🟢Caudate lobe enlargement​ 🟠Nodular contour 🟣Confluent fibrosis 🔵Splenomegaly #radiology #radtwitter #MedTwitter #FOAMrad