CTICasesPulmonary Langerhans Cell Histiocytosis with Superimposed Haemophilus influenzae Bronchiolitis
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Imaging findings
Chest radiograph shows ill-defined, smudgy, fuzzy nodules predominantly in the lower lungs with indistinct vessels. CT reveals extensive tree-in-bud opacities consistent with bronchiolitis, along with numerous thin-walled cysts and some emphysema, primarily in the upper and mid-lungs, sparing the bases.
Key takeaways
This case highlights the co-existence of Pulmonary Langerhans Cell Histiocytosis (PLCH), strongly associated with smoking, and a superimposed acute infection (Haemophilus influenzae bronchiolitis). PLCH typically presents with characteristic cysts and nodules, predominantly in the upper lobes, which can be distinguished from the infectious tree-in-bud pattern. While acute infection requires treatment, cessation of smoking is key for managing PLCH, with follow-up imaging to assess resolution of the infectious component and stability of the underlying cystic changes.
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