TY - JOUR T1 - Bilateral diffuse micronodular changes of radiographic presentation in a 42-year-old woman JF - Breathe JO - breathe SP - 63 LP - 66 DO - 10.1183/20734735.016112 VL - 9 IS - 1 AU - Kyoko Yagyu AU - Tomoyo Morita AU - Munetake Takata AU - Yae Yoshida AU - Daijiro Nabeya AU - Takao Kamimori AU - Mayumi Inaba AU - Hiroshi Fujiwara Y1 - 2012/09/01 UR - http://breathe.ersjournals.com/content/9/1/63.abstract N2 - A 42-year-old woman was found to have abnormal shadow on a chest radiograph obtained during a periodic health examination. She had a history of chronic nonproductive cough on effort for several months. The patient was admitted for investigation. Her past medical history was unremarkable and there were no allergies or occupational exposure. She rarely smoked and consumed little alcohol. During her childhood years, her father had been on chronic treatment for pulmonary tuberculosis. The patient looked well with a blood pressure of 120/64 mmHg, heart rate of 64 beats·min−1, regular respiratory rate of 14 breaths·min−1 and a temperature of 36.8°C. Examination of abdomen, nervous systems and cardiovascular and respiratory system were within normal limits. Finger clubbing wasn't noted on either hand and lymph nodes were not palpable. Her chest radiography and high-resolution CT (HRCT) scans are shown in figure 1. Figure 1 a) Plain radiograph shows micronodular lesions throughout both lungs, which are more prominent in the upper and middle zones. b) High-resolution CT scans of the chest at the level of the right upper lobar bronchus. Task 1How would you interpret the chest radiography and HRCT?Answer 1The chest radiograph (fig. 1a) shows extensive diffuse shadowing in the upper and middle zones predominately and the HRCT (fig. 1b) revealed extensive diffuse lesions in the upper and middle lobes without cavitation, effusion, infiltration or suspicious scattering resource. There were extensive well-demarcated centriacinar nodules and peripheral branching linear structures that formed small Y- and V-shaped lesions. These abnormalities were not present within 5–10 mm of the pleura. Serological studies for HIV, chlamydia and mycoplasma were negative, as were antinuclear antibody, angiotensin-converting enzyme and tumour makers. The exception was a slightly elevated C-reactive protein level (0.76 mg·dL−1). Haematology tests revealed … ER -