CTICasesPulmonary Langerhans Cell Histiocytosis
Imaging findings
A smoker's chest radiograph initially read as showing scattered peripheral nodules is later recognized in retrospect as an upper-lobe-predominant nodular pattern with lower-lobe and lingular sparing. Follow-up CT demonstrates bizarre-shaped cysts admixed with small, ill-defined nodules, upper-lobe predominant with sparing of the lower lobes and lingula.
Key takeaways
Bizarre cystic and nodular change with strict upper-lobe predominance and lower-zone sparing in a smoker is characteristic of pulmonary Langerhans cell histiocytosis, which had been mistaken for metastatic disease at an outside hospital; smoking cessation is the primary treatment, and the case highlights intra-observer variability in appreciating subtle nodularity on serial radiographs.
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