PMC7332465_01
69-year-old male patient who presented with left sided weakness secondary to a TIA. A history of weight loss and anaemia triggered further imaging investigation with a whole body CT, which subsequently lead to the diagnosis of Erdheim-Chest Disease. (a) An AP chest radiograph taken on admission, showing bilateral fine reticular and reticulonodular opacification, predominantly in the upper zones with areas of peripheral ground glass opacification, (black arrows). In addition, there are sclerotic changes in the humeri (red box). (b) Contrast enhanced, coronal CT of the chest, in bony window, shows further evidence of the sclerotic changes in both humeri (red boxes). (c) Contrast enhanced axial image of the chest, in lung window, shows interlobular septal thickening (black arrows) and patchy ground glass opacification in both upper lobes in a crazy paving-type pattern (red boxes). (d) Contrast enhanced axial view of the chest, in mediastinal window, showing a pericardial effusion (black arrows). (e) and (f) Contrast enhanced coronal (e) and axial (f) CT images through the abdomen, in soft tissue window, demonstrating diffuse perinephric soft tissue around both kidneys (black arrows) with additional soft tissue within the region of both renal pelvises and mild dilatation of the intrarenal collecting system (white arrows). (g) Contrast enhanced coronal abdominal CT image, in soft tissue window, demonstrating circumferential periaortic fibrosis, giving a 'coated aorta' appearance (black arrows). The perinephric soft tissue thickening is again demonstrated on this coronal image (white arrows). (h) Contrast enhanced coronal image of the pelvis and proximal femora, in bony window, demonstrating coarsened trabeculae with a mixed pattern of dense sclerosis and lucency.
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F1
As demonstrated in Figure 1, the findings within the chest were a combination of interlobular septal thickening and patchy ground glass opacification, producing a crazy paving pattern, with two ill-defined small solid nodules in the right upper and left lower lobes, respectively.