Chest X-Ray breakdown: looking for subtle abnormalities

Описание: A male in his 40s presents with fatigue and has a Chest X-Ray. What does it show?





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SARCOIDOSIS
👨🏽‍💻This is probably the trickiest and most ‘equivocal’ X-Ray I have posted on here but really wanted to post it as a reminder to really assess those hilar regions

👨🏽‍💻The morphology of the hilar regions is not quite right however it is a very difficult call and was called normal at the time, quite understandably. However it is really important to a) compare to any previous films you have and b) really try and pick out the vessels at the hilum and alarm bells should ring when anything does not satisfy this especially in younger patients where vessels are usually less dilated and tortuous

👨🏽‍💻The CT scan showed classic findings of sarcoid: perilymphatic micronodularity and bilateral symmetrical hilar node enlargement as well as nodes affecting the right axilla

👨🏽‍💻To be definitive a tissue diagnosis is needed and here a right axillary node biopsy showed the classic non caseating granulomas you see in sarcoidosis

👨🏽‍💻The key here is to be able to piece apart the hilar regions - remember to assess the density and morphology

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