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Dr Ahmed Refaey , FRCR

Differential diagnosis of chest diseases. Dr Ahmed Refaey , FRCR. Micronodular ( miliary )disease. TB Histoplasmosis Chicken box Sarcoidosis LCH Pneumoconiosis Alveolar microlithiasis Metastasis. Septal thickening. Beaded / nodular * lymphangitic carcinomatosa

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Dr Ahmed Refaey , FRCR

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  1. Differential diagnosis of chest diseases Dr Ahmed Refaey , FRCR

  2. Micronodular(miliary)disease • TB • Histoplasmosis • Chicken box • Sarcoidosis • LCH • Pneumoconiosis • Alveolar microlithiasis • Metastasis

  3. Septal thickening • Beaded / nodular * lymphangiticcarcinomatosa * sarcoidosis * silicosis • Smooth * lymphangitisccarcinomatosis * pulmonary edema * alveolar proteinosis

  4. Bilateral perihilar air-space disease • Pulmonary edema • Pulmonary hemorrhage • Alveolar proteinosis • PCP

  5. Acute alveolar infiltrate • Pulmonary edema • Pneumonia • Pulmonary hemorrhage • Aspiration

  6. Chronic alveolar disease • Alveolar cell carcinoma • Alveolar sarcoidosis • Lymphoma • Alveolar proteinosis

  7. Unilateral hyperlucent lung • Obstructive emphysema • Mcleoid syndrome ( Swyer James syndrome) • Pneumothorax • Pulmonary embolism • Bullous disease • Air trapping e.g. FB , mass • Poland syndrome

  8. Multiple lung nodules (macronodules) • Metastasis • Wegner’s granulomatosis • Rheumatoid n nodules • AVMs • Septic emboli

  9. Small cavitating lung lesions • Septic emboli • Rheumatoid nodules • Wegner’s granulomatosis • Sq. or transitional cell ca metastasis

  10. Upper lober disease( CASSET P ) • Cystic fibrosis • Ankylosingspondylitis • Sarcoidosis • Silicosis • Esinophilicgranuloma • PCP

  11. Basilar interstitial lung disease ( BADASS ) • Bronchiectasis • Aspiration • Drugs / DIP-UIP • Asbestosis • Sickle cell disease • Scleroderma

  12. Masses with air bronchogram • Lymphoma • Alveolar cell carcinoma • Pseudolymphoma ( maltoma )

  13. Anterior mediastinal mass • Thymic tumors • Substernal Thyroid • LNs • Germ cell tumor

  14. Middle mediastinal mass • LNs • Aneurysm • Esophageal duplication • Bronchogenic cyst

  15. Posterior mediastinal mass • Neurogenic tumors • Paraspinal hematoma • Paraspinal abscess • Extraskeletalhematopoiesis • LNs enlargement • Lateral meningeocele

  16. Opacifiedhemithorax • Atelectasis • Pneumonia • Pleural effusion • Post pneumonectomy

  17. Pneumomediastinum • Ruptured esophagus • Ruptured trachea / bronchus • Iatrogenic • Broncheal asthma • pneumoperitoneum

  18. Pleural calcification • Old TB empyema • Asbestos exposure • Hemithorax

  19. Cardiopherenic angle mass • Pericardial cyst • Diaphragmatic hernia ( Morgagni ) • Lung sequestration • Pericardial fat bad

  20. Unilateral pulmonary edema • Aspiration • Disease in other lung e.g. COPD • Postural • Rapid expansion pulmonary edema “ Look for ICT”

  21. Long segment tracheal narrowing • Tracheopathiaosteoplastica • Tracheo-bronchealamyloidosis • Wegner’s granulomatosis • Intubation injury • Tracheobronchomalacia • Relapsing polychondritis • Papillomatosis ( extensive )

  22. Peripheral distributed lung disease • Esinophilic pneumonia --- upper lobes • BOOP ----- lower lobes • Hypersensitivity pneumonitis • Multiple infarcts • DIP • Alveolar cell carcinoma

  23. Bronchiectasis • CT criteria of bronchiectasis 1- lack of tapering of bronchi 2-internal diameter of bronchus larger than the adjacent artery 3- bronchi are visible within 1 cm of pleura 4- mucus-filled , dilated bronchi

  24. Bronchiectasis • Chronic airway infection • Pulmonary fibrosis –traction bronchiectasis • ABPA ------- central bronchiectasis • Cystic fibrosis ------- apical bronchiectasis • Mounier-Kuhn syndrome – tracheobronchomegally • Kartagner syndrome --- situsinversus + sinusitis

  25. Mounier-Kuhn syndrome

  26. ABPA

  27. Cystic fibrosis

  28. Kartagener’s syndrome

  29. Dilated esophagus • Scleroderma • Achalasia • Obstructing tumor • Drugs ( atropine) • Surgury ( gastric pull-up)

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