I apologize for the missed case Monday - personal emergency. However, this is a good, rare case of the day which I had never heard of (or seen).
This chest X-ray is from a 30 year old man presenting with shortness of breath. He was treated with antibiotics without any improvement. Although sputum AFBs are negative, you take a social history to get an idea of his tuberculosis risk factors. He works in a Portuguese vineyard spraying plants with a fungicidal solution. The rest of his history is noncontributory; he is a nonsmoker. Pulmonary function tests suggest the lesion is interstitial. A thoracotomy was performed (this case is modeled after a case report from 1969) and the visceral pleura had areas that were blue.
Challenge: What's your diagnosis?
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1 comment:
Limewater
Described in Thorax in 1969, this is Vineyard Sprayer’s lung disease, a rare occupational disease due to inhalation of Bordeaux mixture, copper sulfate with limewater. The radiograph demonstrates architectural distortion with upper lobe scarring, cyst-like cavities, coarse scarring, and scattered nodules.
Sources: UpToDate; Thorax.
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