Eighty-five-year-old man with mosaic attenuation on chest imaging

• Published in: BMJ case reports Vol. 2018; p. bcr-2017-222644
• Main Authors: Khalid, Faiza, Rehman, Sofiya, Gupta, Shikha
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 13-01-2018; BMJ Publishing Group
• Subjects: Aged, 80 and over; Airway management; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Case reports; Cough - etiology; Diagnosis, Differential; Dyspnea - etiology; Embolisms; Heparin - administration & dosage; Heparin - therapeutic use; Humans; Images In; Infusions, Intravenous; Lung diseases; Lungs; Male; Mens health; Pulmonary arteries; Pulmonary Embolism - complications; Pulmonary Embolism - diagnosis; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - drug therapy; Thromboembolism; Tomography, X-Ray Computed; respiratory system; venous thromboembolism
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2017-222644

Low attenuation areas on CT chest are abnormal; the differential diagnosis includes small airway lung disease (such as bronchiectasis, cystic fibrosis, constrictive bronchiolitis) and vaso-occlusive disorder like pulmonary embolism (PE). The level of airway obstruction is usually at or near the lobular level that gives a mosaic pattern of normal and hyperlucent lung. 2 In small airway lung disease, enhancement of non-homogeneously attenuated lung parenchyma at the end of expiration has led to the recommendation that expiratory sections should be obtained routinely to assist with the diagnosis. 3 Similarly, in case of PE, the oligaemic lung signifies decrease in size and number of pulmonary vessels as compared with normal lung. Limited value of chest radiography in predicting aetiology of lower respiratory tract infection in general practice.