CTICasesAcute Onset Langerhans Cell Histiocytosis in an Elderly Smoker
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Imaging findings
A 76-year-old patient with known emphysema showed new, acute changes between May and September. The September CT revealed upper lobe predominant nodules, some appearing as "tiny Cheerios" (cavitating nodules), evolving into more irregular and larger cysts, alongside some solid nodules. The lower lobes were spared. The patient was asymptomatic at the time. A biopsy confirmed Langerhans cell histiocytosis.
Key takeaways
This case demonstrates an acute onset of Langerhans cell histiocytosis (LCH) in an elderly, long-term smoker, which is an atypical age presentation (usually younger). The rapid development of classic LCH morphology (nodules, cavitating nodules, cysts, upper lobe predominance, lower lobe sparing) over a four-month period suggests a recent change in smoking habits or immune status, possibly triggered by stress. The morphology and rapid progression differentiate it from other possibilities like adenocarcinoma or infection.
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