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Sometimes it’s tricky to differentiate emphysema from pulmonary Langerhans cell histiocytosis (PLCH). Here are two different patients—both heavy smokers: •Case 1: 82-year-old male •Case 2: 31-year-old male One has PLCH. Which one do you think it is? And how do you distinguish confluent centrilobular emphysema (CLE) from pulmonary Langerhans...

10,646 views • 1 year ago •via X (Twitter)

12 Comments

Eric Goodman's profile picture
Eric Goodman1 year ago

the age of the patients favor case 1 emphysema and case 2 PLCH.

Dr Khaled Ahmed Abuzeid's profile picture
Dr Khaled Ahmed Abuzeid1 year ago

You’re absolutely right—the age does favor emphysema in Case 1 and PLCH in Case 2. But my aim here is to highlight the imaging clues that help differentiate between the two.

Naveen Sankar S's profile picture
Naveen Sankar S1 year ago

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Silvio Name's profile picture
Silvio Name1 year ago

1) emphysema 2) PLCH Usefull clues: Cysts should have a thin wall (not always easy); search for coexistance of nodules in PLCH; in emphysema there shpuld be an artery in the center; All that being said, in some cases differentiation is not as easy as it sounds…

Dr.Doom's profile picture
Dr.Doom1 year ago

LCH never at CP angles CLE mid basal predominant

Younes Abdourabbih's profile picture
Younes Abdourabbih1 year ago

In CLE there is an artery tha runs through its center Another clue to differentiate between them is to search the coexistance of nodules wich will favour Plch

Dr Khaled Ahmed Abuzeid's profile picture
Dr Khaled Ahmed Abuzeid1 year ago

Thank you for your insightful contribution.

Gina Amanda's profile picture
Gina Amanda1 year ago

No 2 is PLCH, we can see the wall of the cyst on the CT

Dr Khaled Ahmed Abuzeid's profile picture
Dr Khaled Ahmed Abuzeid1 year ago

You’re right—perceptible cyst walls are a clue in PLCH. But in confluent centrilobular emphysema, compressed parenchyma can also make walls appear perceptible. What other features can help us tell them apart?

Raffaele Di Giacomo, PhD's profile picture
Raffaele Di Giacomo, PhD1 year ago

Differentiating between emphysema and PLCH can indeed be challenging, especially given shared risk factors like smoking. Typically, PLCH is more common in younger patients and is often characterized by nodular and cystic changes in the lungs. Given the age of the patients, the 31-year-old male might more likely have PLCH but confirmation requires imaging and possibly histological analysis. What distinguishing factors do you look for in imaging to differentiate between these conditions? For comprehensive insights and further review articles on such nuanced topics, check out a dynamic resource for building and accessing biomedical content. #Medicine Support Medical Doctors in Uganda: Help by sharing this GoFundMe! 🙏 ❤️ →

Kamal Tariq's profile picture
Kamal Tariq1 year ago

Following

Dr Khaled Ahmed Abuzeid's profile picture
Dr Khaled Ahmed Abuzeid1 year ago

Thank you for following this case—I hope you found the answer helpful!

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