#Lung_metastasis
#Lung_mass
#RCC
#Cannon_ball

A 59 years old man without any significant past medical history presented with progressive dyspnea and cough and weight loss over the preceding month. He was admitted due to worsening respiratory symptoms.

Chest CT demonstrated multiple bilateral multilobar pulmonary nodules and mass-like lesions with a cannonball appearance, accompanied by bilateral pleural effusions and right lower lobe consolidation.
Pleural effusion thoracentesis showed lymph dominant exudative effusion with normal cytology analysis.

Given the radiologic pattern suggestive of metastatic disease, an abdominal ultrasound was performed, which revealed a right renal mass.
Ultrasound-guided biopsy of the renal lesion confirmed renal cell carcinoma (RCC).

The pulmonary lesions were considered consistent with metastatic RCC.
The patient was subsequently referred to the oncology department for further management.

#COPD
#Emphysema

A 64 years old man with heavy smoking history and diffuse emphysematous changes , and a large emphysematous bulla in the right lower lobe (RLL).

#Learning
#Spirometry
#Small_airway_diseas

The iceberg analogy perfectly illustrates an important concept in respiratory medicine.

A normal spirometry result does not exclude early lung disease.

Small airway disease, often referred to as the “silent zone” of the lungs, can remain undetected by conventional spirometry until a substantial proportion of the small airways has already been affected. This is particularly relevant in:
• Heavy smokers
• Early COPD (Pre-COPD)
• Patients with persistent respiratory symptoms despite normal spirometry
• Occupational or environmental exposure-related lung disease

In symptomatic individuals with normal spirometry, additional investigations such as high-resolution CT (HRCT), body plethysmography (air trapping/RV), DLCO, impulse oscillometry (IOS), or multiple breath nitrogen washout (MBNW) may reveal abnormalities that spirometry alone cannot detect.

Treat the patient—not the spirometry.

#SCC
#Lung_mass
#Lung_nodule
#Lymphangitic_carcinomatosis

A 73 years old man with heavy smoking history presented with progressive cough and dyspnea over the preceding year. He was admitted because of worsening respiratory symptoms.

Chest CT revealed a cavitary lesion in the right hilar region, a spiculated pulmonary nodule in the left upper lobe (LUL), diffuse bilateral pulmonary infiltrates suspicious for lymphangitic carcinomatosis with right upper lobe predominance, and bilateral pleural effusions.

Diagnostic thoracentesis demonstrated a lymphocyte-predominant exudative pleural effusion.

Flexible bronchoscopy was performed, and both bronchoalveolar lavage (BAL) and endobronchial biopsy (BB) specimens were obtained. Histopathological examination confirmed pulmonary SCC.

#Lung_cancer
#Lung_metastasis
#HCC

A 30 years old woman with hepatocellular carcinoma (HCC) presented with multiple pulmonary metastasis.

#ARDS
#Prone_position

The physiological benefits of prone positioning:
promoting a more homogeneous distribution of transpulmonary pressure,
reducing overdistention of dependent regions,
limiting cyclic alveolar collapse,
Reduce ventilator-induced lung injury (VILI).

#ARDS #Prone_position

#Hydatid_cyst

A 69 years old woman with history of pulmonary and hepatic hydatid cysts, status post surgical removal of the pulmonary hydatid cyst, underwent chest CT.
The CT scan demonstrated multiple residual pulmonary and hepatic cystic lesions with calcification (Inactive hydatid cyst), compatible with chronic hydatid cysts.