Imaging Case of the Week 75

The following chest x-rays are from a 60 year old male patient with history of a cough and weight loss. What can you see?

chest x-ray PA

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chest x-ray lateral

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[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The PA and lateral chest x-rays show extensive scattered bilateral miliary and nodular shadowing in bilateral lung fields. There is coalescing of the nodules in the lower zones, especially on the right side. There is no pleural effusion. The cardiac size is within normal limits.

Differential diagnosis would be:

  • Infection – miliary tuberculosis, fungal.
  • Miliary metastasis from thyroid, renal carcinoma, malignant melanoma.
  • Primary lung carcinoma – bronchoalveolar carcinoma (a subtype of adenocarcinoma with lepidic predominance on histology).
  • Sarcoidosis / Silicosis

This patient was later diagnosed with bronchoalveolar carcinoma based on the histopathology of a biopsied specimen.