CTICasesPulmonary Langerhans Cell Histiocytosis (PLCH) - Milder Spectrum (RBILD Transition)
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Imaging findings
Chest CT of a patient with an extensive smoking history showed a milder spectrum of disease, with ill-defined centrilobular nodules, some with early cavitation, and scattered areas of bronchiectasis, particularly in the right apex. As in the classic presentation, lung bases and costophrenic angles were spared. The presence of lymph node enlargement was also noted, prompting differential considerations.
Key takeaways
PLCH can present with a milder spectrum, sometimes overlapping with respiratory bronchiolitis-interstitial lung disease (RBILD). Early cavitation and centrilobular nodules in a smoker, with characteristic regional sparing, suggest the diagnosis. The co-occurrence of lymphadenopathy should prompt consideration of other differential diagnoses or associated disorders like lymphoma.
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