Chest X-ray ward round

Case 6:

A 60-year-old smoker presents with known COPD presents with increased SOB

Chest CXR (Click to enlarge)

Questions:

What does the X-ray show?

What is the diagnosis and differentials?

What is the management?

Investigations

Bloods including FBC (?splenic or marrow involvement), renal function, LFTs, Calcium, ACE
Detailed pulmonary function test with gas transfer
Bronchoscopy BAL with EBUS

Management for sarcoidosis

Systemic steroids
Second-line treatment options for sarcoidosis: Methotrexate, azathioprine, mycophenolate mofetil or leflunomide

Notes:

Bilateral reticular abnormality within the upper and mid zones with volume loss, BHL