First of all I suggest that you watch this video in HD and in full screen by adjusting the settings on your player so that you can appreciate fine
details of the images. Once again our normal chest x-ray is in front of us and compare it with the x-ray that on your left hand side . If you have
seen few normal chest x-rays you will realize very quickly that there is definitely something wrong with this patient on your left hand side.
The mediastinum is wide in this area on this patient. There is a mass effect in Aorto plumonary. window so the aorto pulmonary
window compare it with normal x-ray, there is a mass effect here.
So first thing that comes to mind after seeing the mediastinal widening in this area would be enlarged lymph nodes. You can see abnormal
opacities in both lungs, here as well. And thre is an abnormal lucency here and in this area and most probably in this area
You would agree that there is a reticulonodular pattern. And there are fibrotic changes in mid zones on both sides.
And as the lung shrinks in volume as a result of fibrosis it can produce what is known as traction bronchiectasis. So shrinking
intestitum pulls bronchi to dilate them in a non uniform manner. So this is most probably a dilated bronchial branch you can see thick walls
on both sides and this is the same thing, a dilated bronchial branch.
An axial CT scan image from the same patient, a bit below from carina. And you can can see calcified lymph nodes, you can see calcification
here and you can see calcification here.
An HRCT image from the same patient a cut taken just below the level of carina. So this is carina here. Right main bronchus left main
bronchus and you can see traction bronchiectasis here, here and here as well. So the dilatation of the bronchial branches is visible
clearly. So this is a bit small from here an bit more dilated from here. You can see thickened walls of the bronchial brances.
Normal bronchial tree should taper towards the periphery. Which is not the case in this case.
On this image you can see what are known as Perilymphatic nodules visible on both lungs. These are nodules within interstitum Nodules
can be subpleural, they can also be present along fissures or along interlobular septa, and adjacent to the bronchovascular bundles.but
before I continue on this I want to show you another image from a different patient.
OK another image with perilymphatic nodules. And as I said these are the nodules within
interstitium. I guess it could be very difficult for a newbee to agree with me but I just wanted to make a point the most convincing thing for me
would be to show you this fissure. Which is a sort of beaded in shape unlike this smooth and regular line. So these beaded shaped structures
are perilymphatic nodules which as I said can be present within, which can be present along the fissure and within the linterlobular septae as
well as adjacent to bronchovascular bundles. So all the features mentioned so far that is lung fibrosis, traction bronchiectasis and presence of
perilymphatic nodules are suggestive of interestitial lung disease. In this case both patients have been diagnosed with sarcoidosis.
Please note that the patient, the first patient also has enlarged lymphodes which along with the presence of all the features mention before
should make you think of Sarcoidosis. Also note that the most common cause of perilymphatic
nodules is Sarcoidosis although they can also be present in other interstitial conditions.