Chest imaging: pulmonary Langerhans cell histiocytosis: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Chest imaging: pulmonary Langerhans cell histiocytosis

Sample item

A 30-year-old heavy smoker has dyspnoea and a pneumothorax. HRCT shows upper zone predominant nodules and bizarre-shaped thick-walled cysts, sparing the costophrenic angles. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Pulmonary Langerhans cell histiocytosis

Smoking-related Langerhans cell histiocytosis starts as centrilobular nodules that cavitate into irregular cysts, upper zone predominantly with sparing of the bases. Smoking cessation is the first step in management.

Option by option

  • A. Pulmonary Langerhans cell histiocytosis (correct)

    Correct. Upper zone nodules and bizarre cysts in a smoker point to this disease.

  • B. Asbestosis

    Asbestosis is basal with pleural plaques.

  • C. Lymphangioleiomyomatosis

    LAM gives uniform thin-walled cysts in women with no nodules.

  • D. Lower lobe usual interstitial pneumonia

    UIP is basal and subpleural.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is A, Pulmonary Langerhans cell histiocytosis. Smoking-related Langerhans cell histiocytosis starts as centrilobular nodules that cavitate into irregular cysts, upper zone predominantly with sparing of the bases.

Why is "Asbestosis" not the answer?

Asbestosis is basal with pleural plaques.

Why is "Lymphangioleiomyomatosis" not the answer?

LAM gives uniform thin-walled cysts in women with no nodules.

Why is "Lower lobe usual interstitial pneumonia" not the answer?

UIP is basal and subpleural.

What concept does this question test?

It tests Chest imaging: pulmonary Langerhans cell histiocytosis in Radiology. Smoking cessation is the first step in management.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Chest imaging: pulmonary Langerhans cell histiocytosis?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.