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Pulmonary Langerhans cell histiocytosis, a nodular and eventually cystic lung disease of the upper and mid lung zones, is a disorder of cells with Langerhans cell phenotype.
TB in the upper zones is usually common in HIV seronegative patients who have high CD4 counts and are immunocompetent, therefore it is not surprising that HIV patients with high CD4 counts will have upper lung zone involvement.
An aberrant right pulmonary artery arising from the abdominal aorta at the origin of the superior mesenteric artery (SMA) supplying the right lower lung zone was also demonstrated.
He was worked up as per protocol and antero-posterior chest radiography showed consolidation of the right upper lung zone with multiple cavitary lesions in the right infra hilar region.
Dullness to percussion, bronchial breath sounds, and egophony were elicited in the left lower lung zone.
Chest expansions were asymmetric, with decreased expansion of the right hemithorax, decreased breath sounds on the right upper lung zone and crackles in the right, mid to lower lung zones.
HP: poorly defined centrilobularmicronodules, widespread ground-glass opacities, mosaic attenuation and air trapping with a predominance of disease in upper and middle lung zones under appropriate clinical setting.
The patient also had decreased breath sounds in both lower lung zones and moderate pitting edema up to the knees.
In the case of emphysema, there is often apical predominant destruction of lung tissue, confining edema in a regional distribution to the lower lung zones.
Furthermore, PLCH predominates in the upper and mid lung zones, a feature common in many smoking-related lung diseases.