Pulmonary Fibrosis- CXR

76 yr old compalints of shortness of breath with history of COPD with decreased oxygen saturation with no definite occupational history relating to toxins/pollutants. There is extensive, ill defined reticular hard shadowing  in all zones  with suggestion of Rt CP angle blunting and rt diaphragmatic, possible calcium with no significant Rt ventricular enlargement  on this film.

Best  described as Dirty lung fields.

Teaching points

-Hard reticular shadows with some subpleural nodules  with at places loss of  tissue interfaces

-Rt pleural thickening along with plaque diaphragmatic region

-Questionable mediastinal adenopathy

-Few areas of focal hyper inflation

-Heart not conformity to  COPD with pulmonary conus not full

Xray diagnosis could suggest Pulmonary fibrosis - needs compariosn with old Xrays/ HRCT evaluation

Pulmonary fibrosis

Definition: literally scarring andreplacemnt of lung tisue with fibrous tisue

Classification: at the most confusing and rapidly changing as the etiology and types are broad progresses rapidly after 40s and 50 s, presents with shortness of breath and dry cough, typically misdiagnosed initially in view of clinical mimic to infection/embolism/COPD/ heart failure /Asthma etc. Xray chest could be normal adding to the misdiagnosis

Restrictive lung disease suggested by maintained FEV1/Fvital capacity  , though the latter is decreased  depending on the etiology radiolgical features vary idiopathic may show usual interstitial patern(UIP)  

More on this will be presented with HRCT picture -look out for it.