Acute lupus pneumonitis, pulmonary hemorrhage, bronchiolitis obliterans organizing pneumonia, constrictive bronchiolitis, chronic interstitial pneumonitis and fibrosis, and pulmonary vascular disease are the main pulmonary manifestations of systemic lupus erythematosus. Imaging findings vary depending on the specific manifestation but may include ground glass opacities, consolidation, nodules, septal thickening, and signs of pulmonary hypertension. Pulmonary infections, especially tuberculosis, are also important indirect pulmonary complications of SLE due to immunosuppression from the disease or its treatments.
Lecture slides about bronchiectasis with contents including definition, causes, pathogenesis and pathology, and how to make diagnosis. Treatment for bronchiectasis is presented separately.
Scleroderma Associated Lung Disease is presented by
Jane Dematte MD, MBA, Director, ILD program
Division of Pulmonary and Critical Care, Northwestern Feinberg School of Medicine
A detailed description of sarcoidosis, pulmonary in specific but also covering the other systems. a rare entity in india or a better way to say, often an overlooked disease.
Lecture slides about bronchiectasis with contents including definition, causes, pathogenesis and pathology, and how to make diagnosis. Treatment for bronchiectasis is presented separately.
Scleroderma Associated Lung Disease is presented by
Jane Dematte MD, MBA, Director, ILD program
Division of Pulmonary and Critical Care, Northwestern Feinberg School of Medicine
A detailed description of sarcoidosis, pulmonary in specific but also covering the other systems. a rare entity in india or a better way to say, often an overlooked disease.
PNEUMONIAS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPORE KASHMIRProf Dr Bashir Ahmed Dar
pneumonias made very easy for medical students and doctors.stress given on history taking and to arrive at correct diagnosis.EMAIL-drbashir123@gmail.com
COPD are chronic obstructive airway diseases usually need CT scans for early diagnosis and followup. this ppt will give you a brief idea about imaging in COPD.
Bronchiectasis ( Bronchos- airways ; ectasia- dilatation) is a morphological term used to describe abnormal irreversibly dilated and often thick walled bronchi.
Bronchiectasis represents the end stage of variety of pathological precesses that cause destruction of bronchial wall and its surrounding tissues.
Describes the basic radiology of diffuse interstitial disease ,with differential diagnosis of reticular interstitial pattern and how to approach HRCT findings .
Similar to Pulmonary manifestations of systemic lupus erythematosis (20)
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. ACUTE LUPUS PNEUMONITIS
Acute lupus pneumonitis is an abrupt febrile
pneumonic process mostly without infectious
etiology, and antibiotics usually fail to favorably alter
its course.
A favorable response to corticosteroid, with
normalization of the clinical and radiological
manifestations, can be helpful in establishing its
diagnosis.
3. The histopathologic findings include alveolar wall
damage and necrosis, inflammatory infiltrates,
hemorrhage, edema, and hyaline membrane.
The radiologic findings consist of patchy unilateral
or bilateral areas of ground glass opacity or air
space consolidation, involving mainly lung bases
4. FRONTAL CHEST RADIOGRAPH SHOWS ILL-DEFINED HAZY OPACITIES IN BOTH LOWER LUNGS.
THIN-SECTION CT AT THE LEVEL OF BASAL LUNG SHOWS AREAS OF NODULAR CONSOLIDATION AND
GROUND-GLASS ATTENUATION IN BOTH LOWER LOBES.
5. A. FRONTAL CHEST RADIOGRAPH SHOWS FOCAL AIR-SPACE CONSOLIDATION
IN THE LEFT UPPER LUNG.
B. CT SCAN AT THE LEVEL OF THE AORTIC ARCH SHOWS AIR-SPACE CONSOLIDATION
AND MULTIPLE, ILL-DEFINED NODULAR OPACITIES. LABORATORY
STUDIES, INCLUDING BIOPSY OF THE LUNG, DID NOT REVEAL ANY INFECTIOUS
ORGANISM AT THIS TIME.
6. THIN-SECTION CT AT THE LEVEL SIMILAR TO B, OBTAINED AFTER
STEROID MEDICATION FOR 1 MONTH, SHOWS IMPROVEMENT OF THE CONSOLIDATION
BUT NEWLY DEVELOPED LUNG CYSTS OR AIRWAY DILATATION
(ARROWS).
7. CHEST X-RAY SHOWING DIFFUSE ALVEOLAR
INFILTRATES IN A PATIENT WITH ACUTE LUPUS
PNEUMONITIS
8. PULMONARY HEMORRHAGE
Pulmonary hemorrhage in SLE, varies from a mild,
subclinical,chronic form to acute, massive, life-
threatening bleeding.
In patients with hemoptysis, two find ings may
suggest significant pulmonary hemorrhage:
1. A marked drop in hematocrit over a period of 12
to 36 hours.
2. Unexplained increase in the diffusive capacity of
carbon monoxide, or DLCO.
*(Hemoptysis and hypoxemia, may be lacking even where
hemorrhage is severe.)
9. Chest radiography depicts areas of ill-defined,
patchy, acinar opacity that are usually bilateral and
located in the lower lung zones .
With the cessation of hemoptysis, the findings of
radiography improve rapidly and often normalize
within 2-4 days.
10. CT demonstrates ground-glass opacity and,
sometimes, frank consolidation.
A nodular pattern with no zonal predominance or
bronchocentricity may be also seen, especially
during complete or partial clinical remission.
12. BRONCHIOLITIS OBLITERANS ORGANIZING
PNEUMONIA
Is a pathologic entity characterized by the formation
of plugs of fibrous tissue in bronchioles and alveolar
ducts.
Most cases are idiopathic, but a BOOP-like reaction
has been described in association with several
connective tissue diseases including SLE.
13. Bronchiolitis obliterans organizing pneumonia
typically manifests with scattered, bilateral ground-
glass attenuation or air space consolidation.
All lung zones are equally affected.
14. FRONTAL CHEST RADIOGRAPH SHOWS CARDIOMEGALY, BILATERAL PLEURAL
EFFUSION, AND PERIPHERAL PATCHY INCREASED OPACITIES, PREDOMINANTLY
IN THE RIGHT LUNG.
THIN-SECTION CT SCANS AT LEVELS OF THE AORTIC ARCH
CONSOLIDATIONS PREDOMINANTLY IN THE PERIPHERAL LUNG.
INTERLOBULAR SEPTAL THICKENING AND DILATED PULMONARY VEINS (ARROWHEAD)
INDICATE PULMONARY CONGESTION ASSOCIATED WITH LUPUS
CARDIAC DISEASE.
15. CONSTRICTIVE BRONCHIOLITIS (OBLITERATIVE
BRONCHIOLITIS)
At lung function testing, constrictive bronchiolitis is
characterized by airflow obstruction due to
submucosal and peribronchiolar inflammation and
fibrosis, which primarily involves respiratory
bronchioles, and the absence of diffuse
parenchymal inflammation.
16. The most obvious thin-section CT findings are
focal, often sharply defined, areas of decreased
lung attenuation associated with vessels of
decreased caliber in the absence of parenchymal
consolidation; bronchiectasis, mainly at a
subsegmental level, may also be noted
Expiratory CT shows focal areas of air trapping
consistent with small airway obstruction.
17. INSPIRATORY THIN-SECTION CT AT LEVELS OF THE SUPERIOR SEGMENTAL
BRONCHUS OF THE LOWER LOBE (A) AND BASAL LUNGS (B) SHOW
MOSAIC ATTENUATION IN BOTH LUNGS. PULMONARY VESSELS IN LOWER
ATTENUATION AREAS ARE SMALLER IN CALIBER AND NUMBER THAN THOSE
IN HIGHER ATTENUATION AREAS
18. CHRONIC INTERSTITIAL PNEUMONITIS AND
FIBROSIS
The prevalence of clinically significant interstitial
lung disease in SLE has been reported in as few as
1-6% of patients.
The radiographic findings include bibasilar areas of
irregular linear opacity, ground-glass attenuation,
and loss of lung volume .
19. The typical CT appearance includes interlobular
and intralobular interstitial thickening, areas of
ground-glass attenuation. traction bronchiectasis
with predominantly subpleural and basal
involvement.
End-stage disease is accompanied by
honeycombing, traction bronchiectasis, and
achitectual distortion, as in the case of usual
interstitial pneumonitis .
20. Although the disease which complicate SLE
resemble those of idiopathic pulmonary fibrosis,
including both usual and nonspecific interstitial
pneumonitis, both pathologically and radiologically,
its course is usually less severe from clinical and
functional points of view.
21. A. INSPIRATORY THIN-SECTION CT AT THE LEVEL OF BASAL LUNGS SHOWS FOCAL, RELATIVELY
WELL DEFINED NORMAL AREAS OF INCREASED ATTENUATION (ARROWS) INTERSPERSED WITH
RADIOLUCENT AREAS INDICATIVE OF AIR TRAPPING. ALSO, NOTE BRONCHIAL DILATATION.
B. EXPIRATORY THIN-SECTION CT AT THE SAME LEVEL AS A SHOW MARKED AIR TRAPPING
22. PULMONARY VASCULAR DISEASE
Pulmonary vascular involvement in SLE may
include the capillary, arterial, and venous systems.
Venous involvement, however, is radiographically
distinct from pulmonary hypertension caused by
arterial involvement.
23. PULMONARY VENO-OCCLUSIVE DISEASE
Pulmonary veno-occlusive disease is a rare form of
pulmonary hypertension characterized
pathologically by repeated pulmonary venous
thrombosis.
Clinically by pulmonary arterial hypertension and
edema.
24. Radiographically, pulmonary veno-occlusive
disease shows signs of pulmonary arterial
hypertension very similar to those associated with
primary pulmonary arterial hypertension or
thromboembolic disease, but includes an important
additional sign of pulmonary edema.
25. The most common CT findings include smooth
interlobular thickening and areas of ground-glass
attenuation consistent with interstitial pulmonary
edema, enlarged central pulmonary arteries, and
pulmonary veins of normal caliber.
26. A. FRONTAL CHEST RADIOGRAPH SHOWS PROMINENT HILAR SHADOWS AND DIFFUSE HAZINESS IN BOTH
LOWER LUNGS. ALSO NOTE LEFT PLEURAL EFFUSION
(ARROW ).
B. THIN-SECTION CT AT THE LEVEL OF BASAL LUNGS SHOWS THICKENING OF INTERLOBULAR SEPTA (LONG
ARROW) AND BRONCHIAL WALL, AND FOCAL CONSOLIDATIONS
(SHORT ARROWS).
27. PULMONARY ARTERIAL HYPERTENSION
In approximately 10% of SLE patients, clinically
evident pulmonary arterial hypertension is present .
The potential mechanisms of the condition include
interstitial pneumonitis, small pulmonary arterial
vasculitis, thrombosis in situ or pulmonary
thromboembolism, and primary pulmonary
hypertension.
28. Vascular abnormalities typically afflict small
muscular arteries.
During the early phase, chest radiographic findings
may be normal, but advanced radiographic findings
include enlargement of the right ventricle, and
prominent main pulmonary artery with distal
attenuation of the arteries
29. Ventilation/perfusion scanning or pulmonary
angiography can help exclude pulmonary
embolism.
30. FRONTAL CHEST RADIOGRAPH SHOWS TYPICAL FEATURES OF PULMONARY ARTERIAL
HYPERTENSION, INCLUDING BULGING OF THE PULMONARY CONUS
(ARROWHEADS) AND PROMINENT PROXIMAL PULMONARY ARTERIES.
B. THIN-SECTION CT OBTAINED BEFORE CONTRAST ADMINISTRATION SHOW THE ENLARGED
PULMONARY TRUNK (P), WHICH IS LARGER IN DIAMETER
THAN THE ASCENDING AORTA (A). ALSO NOTE ENLARGED LEFT PULMONARY ARTERIES
(ARROWS).
31. SECONDARY INVOLVEMENT OF THE
RESPIRATORY SYSTEM
Severe multi-organ diseases often confound the
clinical status of patients with SLE, treatment for
such disease, and its attendant complications.
Renal failure, central nervous system involvement,
or cardiac involvement may lead to pulmonary
edema.
32. PULMONARY EDEMA IN A 34-YEAR-OLD WOMAN WITH SLE.
THIN-SECTION CT AT THE LEVEL OF THE DIAPHRAGM SHOWS TYPICAL
FEATURES OF PULMONARY EDEMA, INCLUDING DILATED PULMONARY
VESSELS (ARROW ), SMOOTH THICKENING OF THE INTERLOBULAR SEPTA
(ARROWHEADS), AND AREAS OF GROUND-GLASS ATTENUATION.
33. Pericardial effusion, neuromuscular disease, and
diaphragmatic dysfunction can affect the respirator
system, resulting in passive atelectasis and oxygen
therapy or cytotoxic chemotherapy may cause
pulmonary toxicity.
Infection, however, is the most important cause of
indirect involvement of the lungs in SLE.
34. Shrinking lung syndrome (SLS) is a rare
manifestation of SLE.
It was first described in patients with lupus who
presented with unexplained dyspnea, decreased
lung volumes and elevation of the diaphragm on
radiographic imaging and restriction on pulmonary
function tests in the absence of any parenchymal
disease.
35. Clinically, patients present with dyspnea that is
particularly worse when supine.
Pleuritic chest pain is present in 65% of patients.
Physical examination reveals diminished breath
sounds at the lung bases with or without basilar
crackles.
Chest radiographs and CT show elevation of both
diaphragms with basal linear atelectasis and
without any evidence of parenchymal lung disease.
36. Assessment of respiratory muscles show reduced
maximal inspiratory pressure (MIP) and stable
maximal expiratory pressure (MEP).
Diaphragmatic weakness can be established by
measuring the transdiaphragmatic pressure or by
doing electromyography of the diaphragms.
Autopsy findings include diffuse fibrosis and
atrophy of the diaphragms.
Oral glucocorticoids with or without
immunosuppressive medications have been shown
effective.
37. PULMONARY INFECTION OTHER THAN
TUBERCULOSIS IN SLE
Pulmonary infection is a major cause of morbidity
and mortality in SLE, with either common bacterial
agents or more unusual opportunistic organisms
causing pulmonary infections.
Opportunistic infections in SLE patients include
aspergillosis, cryptococcosis, pneumocystis carinii
,cytomegalovirus, and nocardia.
38. The risk of infection in the absence of
immunosuppression is small, though an aggressive
diagnostic approach to exclude infection in any
patient with SLE presenting with new pulmonary
infiltrates is warranted, particularly if
immunosuppressive therapy is ongoing.
39. THIN-SECTION CT SCANS AT LEVELS OF THE AORTIC ARCH (A) AND BASAL LUNGS (B) SHOW
MOSAIC PATTERN OF GROUND-GLASS OPACITIES ADMIXED
WITH INTRA- AND INTERLOBULAR SEPTAL THICKENING, NAMELY CRAZY-PAVING APPEARANCE.
ALSO NOTE CLEAR SPARING OF ISOLATED SECONDARY
LOBULES (ARROWS). LEFT LUNG SHOWS FIBROSIS AND MARKED VOLUME CONTRACTION
SECONDARY TO LONGSTANDING TUBERCULOSIS. THE ORGANISM
WAS ISOLATED FROM BRONCHOALVEOLAR LAVAGE FLUID.
40. PULMONARY TUBERCULOSIS IN SLE
Pulmonary tuberculosis in patients with SLE may
manifest differently than in immunocompetent
patients, and because of the abnormal functioning
of alveolar macrophages and exposure to
corticosteroid and cytotoxic drugs, the incidence in
the former may be higher.
41. Delayed diagnosis may contribute to a higher
incidence of miliary, far-advanced, and
extrapulmonary tuberculosis.
In patients with SLE who are taking steroids, the
radiologic findings can be similar to those seen in
secondary tuberculosis, such as areas of apical
nodular opacity or in primary tuberculosis, such as
large air-space consolidation, lymphadenitis, pleural
effusion, or miliary tuberculosis.
42. Thin-section CT findings of miliary tuberculosis
resemble those described in that previous report:
miliary nodules associated with interlobular septal
thickening, intralobular reticulation, ground-glass
attenuation, and pleural effusion.
43. A. MAGNIFIED FRONTAL CHEST RADIOGRAPH SHOWS POORLY-DEFINED NODULAR AND LINEAR
OPACITIES IN BOTH UPPER LUNGS.
B. MAGNIFIED THIN-SECTION CT SHOWING THE RIGHT LUNG APEX REVEALS CENTRILOBULAR
NODULAR AND BRANCHING OPACITIES (ARROWHEADS) IN THE
RIGHT UPPER LOBE.
44. A. PLAIN CHEST RADIOGRAPH OBTAINED AT ADMISSION SHOWS INNUMEROUS TINY
NODULAR SHADOWS IN THE ENTIRE LUNG.
B. THIN-SECTION CT AT THE LEVEL OF THE CARINA SHOWS MILIARY NODULES OF
RANDOM DISTRIBUTION AND AREAS OF GROUND-GLASS ATTENUATION.