张佳胤 20:26
张佳胤 20:26
take a look first
话雪 20:27
都是钙化啊，那考虑淀粉样变
话雪 20:27
鉴别：转移癌，骨来源
小明 20:27
@山东省立呼吸 张嵩 支持
阳光明媚 20:29
支持
张佳胤 20:29
its a typical case. but please try to discuss in English
爱宝贝 20:29
感觉像淀粉样变性[呲牙]
张佳胤 20:35
anyone?
张佳胤 20:37
what is the major imaging findings?
阚 20:40
实变 钙化
张佳胤 20:40
consolidation and calcification
张佳胤 20:40
yes
師，善奏者也！ 20:40
multiple pulmonary consolidation with patchy calcification
张佳胤 20:40
please discuss in English
阚 20:41
ok
師，善奏者也！ 20:42
no plueral effusion
阚 20:42
lower lubar
師，善奏者也！ 20:43
张佳胤 20:43
is air bronchogram present?
阚 20:44
yes
師，善奏者也！ 20:44
yes，it is
雷震子1717 20:45
no[撇嘴]
影像y 20:45
是正常肺组织还是扩张支气管？
影像y 20:45
同意李老师！NO
张佳胤 20:46
air bronchogram is present in the lesion of right middle lobe
张佳胤 20:47
what is the distribution of lesions
张佳胤 20:47
upper predominant or lower predominant?
张佳胤 20:47
peripheral or central?
雷震子1717 20:48
peripheral
阚 20:48
lower
张佳胤 20:48
what is the most specific sign?
影像y 20:48
ALL of above
雷震子1717 20:48
张佳胤 20:49
i think it is diffuse calcification, all agree?
阚 20:49
calcification?
阚 20:49
yes
雷震子1717 20:49
i don\’t think this is air bronchogram
张佳胤 20:50
so which lesion is likely to present with diffuse calcification?
雷震子1717 20:51
淀粉样变，骨或软骨转移瘤，甲旁亢，肾衰，肺泡微石症～～
张佳胤 20:51
multiple lesions with diffuse calcification
阚 20:52
amyloidosis
雷震子1717 20:53
还碰到过肝癌栓塞剂到肺里～
张佳胤 20:53
ok let\’s take a look one by one
张佳胤 20:53
first is amyloidosis
小明 20:53
组织细胞胞浆病也可以钙化。
张佳胤 20:54
most have mentioned it as the first diagnosis
阚 20:54
cryptogenic organizing pneumonia
张佳胤 20:56
the common finding of pulmonary amyloidosis is nodular or pachy opacification, typically with calcification
张佳胤 20:56
usually with tracheal involvement
张佳胤 20:57
but sometimes could be without tracheal involvement
张佳胤 20:58
so it comply with the imaging features of amyloidosis
张佳胤 20:59
second, calcified metastasis
師，善奏者也！ 20:59
seems to be pulmonary alveolar microlithiasis
张佳胤 21:00
which is usually seen in patients with OS, chondrosarcoma, mucous adenocarcinoma
師，善奏者也！ 21:00
malignancy is less likely
张佳胤 21:00
but consolidation is rarely the form of calcified metastasis
张佳胤 21:01
third, metastatic calcification, which is completely different to calcified metastasis
张佳胤 21:02
metastatic calcification is seen in patients with metabolic disorders
師，善奏者也！ 21:02
malignancy is less likely for there is no plueral effusion
影像y 21:03
what is OS?
张佳胤 21:04
OS is osteosarcoma, which tends to have ossified metastasis
张佳胤 21:05
the fourth is microlithiasis
師，善奏者也！ 21:05
张佳胤 21:06
which usually shows diffuse micro nodular calcification. but consolidation is also rare
张佳胤 21:07
fifth, silicosis, could present with calcified mass or nodule or consolidation
张佳胤 21:07
but usually upper lobe predominant
雷震子1717 21:08
哦，对哦，忘记最常见的尘肺了
张佳胤 21:08
with pleural involvement
師，善奏者也！ 21:09
imaging findings is severe with no symptom
张佳胤 21:09
so what is your choice now. i will give 3 minutes and everyone pick an answer.
张佳胤 21:16
no is gonna make a guess?
张佳胤 21:16
no one?
師，善奏者也！ 21:16
feel no orientation
雷震子1717 21:17
amyloidosis
師，善奏者也！ 21:18
i guess pulmonary alveolar microlithiasis
张佳胤 21:20
迷失 21:20
Endobronchial tuberculosis or amyloidosis
師，善奏者也！ 21:21
guess with no strong basis
张佳胤 21:22
pulmonary amyloidosis, typical findings
師，善奏者也！ 21:22
師，善奏者也！ 21:39
History repeats once again，but imaging findings are significantly different！
张佳胤 21:39
amyloidosis sometimes is asymptomatic
師，善奏者也！ 21:40
師，善奏者也！ 21:40
刘宏炜 21:41
@旷小春-沪奉中心-放射科 [强][强][强]
師，善奏者也！ 21:44
@张佳胤上海六院放射科 sincerely respects to Teacher Zhang
张佳胤 21:46
谢谢大家[微笑]
陶轟 21:46
定期英文病例讨论
陶轟 21:48
@张佳胤上海六院放射科 @旷小春-沪奉中心-放射科 感谢二位老师[玫瑰][玫瑰][玫瑰]