10/15/18 Goldstein Morning Report

Hussain Basrawala presented an interesting case of a 51 year old male complaining of chronic non-productive cough and weight loss, and was found to have diffuse pulmonary infiltrates (CXR and CT Chest shown below). The patient was eventually diagnosed with metastatic pancreatic cancer.

Evaluation of diffuse pulmonary infiltrates

  • Differential can be split into benign diseases and malignant diseases.
  • Malignant disease is more likely to have multiple pulmonary nodules greater than 1 cm while those less than 5mm are more likely to be associated with benign disease.
  • Benign causes:
    • Abscesses
    • Septic emboli
    • Fungal and parasitic infections
    • Tuberculosis and MAC
    • Vasculitides (GPA most common), RA, sarcoidosis, hypersensitivity pneumonitis
    • Pneumoconioses
  • Malignant causes:
    • Solid organ tumors
      • Most
    • Non-Hodgkin lymphoma
    • Kaposi’s sarcoma in HIV+ patients
  • Typically sarcoidosis, lymphomas, tuberculosis, fungal diseases, pneumonconioses and malignancies are associated with lymph node enlargement.

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