QJM: An International Journal of Medicine, 2015, 743–744 doi: 10.1093/qjmed/hcv044 Advance Access Publication Date: 6 February 2015 Clinical picture
CLINICAL PICTURE
Cheerios in the lung: a rare but characteristic radiographic sign adenocarcinoma, metastatic sarcoma, metastatic squamous cell carcinoma and lymphoma, but there are also documented findings in systemic inflammatory conditions such as cytoplasmic antineutrophil cytoplasmic antibodies vasculitis and pulmonary Langerhans cell histiocytosis.2,3 In this case, histology revealed a pulmonary Langerhans cell histiocytosis, a subtype of histiocytosis that primarily affects long-term smokers. Smoking cessation is regarded as causal therapy, but drug therapy and even lung transplantation may be considered necessary in selected patients. The prognosis ranges from complete recovery to progression of disease.4 Conflict of interest: None declared.
Photographs and text from: D. Aktuerk, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK; M. Lutz, Department of Internal Medicine A, University Hospital of Mu¨nster, Mu¨nster, Germany; D. Rosewarne, Department of Radiology, New Cross Hospital, Wolverhampton, UK; H. Luckraz, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK. email: [email protected]
Figure 1. (a, b) CT images of the lung in a 52-year-old woman showing multiple cavitary nodules (arrows) representing the so-called ‘Cheerios’.
C The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. V
All rights reserved. For Permissions, please email: [email protected]
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A 52-year-old woman presented with a 3-month history of right pleuritic chest pain and recent night sweats. In terms of premedical history, she had a 30 pack-year smoking history but denied any environmental exposure. There was no evidence of tuberculosis exposure or a positive tuberculin test in the past. She denied weight loss and her travel history included visits only to European countries. Physical examination showed no evidence of jaundice, anaemia, cyanosis, clubbing or lymphadenopathy. On auscultation, the chest was clear with bilateral free air entry and there were no cardiac murmurs. A chest x-ray obtained on presentation was normal and did not show any lung pathology. A computed tomography (CT) scan revealed multiple cavitary nodules within the lung bilaterally especially in the right upper lobe. The so-called ‘Cheerios’ in the lung appear on CT images as one or multiple nodules of variable sizes with hypodense centres. Thus, they received their name after the ‘O’-shaped breakfast cereal ‘Cheerios’.1 They usually present as a small, hoop like and fairly uniform shadowing embedded in normal surrounding lung (Figure 1a and b, arrows). The ‘Cheerios’ in the lung have their origin in the peribronchiolar proliferation of malignant as well as non-malignant cells. Thus, the differential diagnosis includes bronchioloalveolar carcinoma, metastatic
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QJM: An International Journal of Medicine, 2015, Vol. 108, No. 9
References 1. Reed SL, O’Neil KM. Cheerios in the chest. Chest 1993; 104: 1267–8. 2. O’Donovan PB. The radiologic appearance of lung cancer. Oncology 1997; 11:1387–402.
3. Chou SH, Kicska G, Kanne JP, Pipavath S. Cheerio sign. J Thorac Imaging 2013; 28:W4. 4. Abbott GF, Rosado-de-Christenson ML, Franks TJ, Galvin JR. From the archives of the AFIP: pulmonary Langerhans cell histiocytosis. Radiographics 2004; 24:821–41.
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CLINICAL PICTURE
Cheerios in the lung: a rare but characteristic radiographic sign adenocarcinoma, metastatic sarcoma, metastatic squamous cell carcinoma and lymphoma, but there are also documented findings in systemic inflammatory conditions such as cytoplasmic antineutrophil cytoplasmic antibodies vasculitis and pulmonary Langerhans cell histiocytosis.2,3 In this case, histology revealed a pulmonary Langerhans cell histiocytosis, a subtype of histiocytosis that primarily affects long-term smokers. Smoking cessation is regarded as causal therapy, but drug therapy and even lung transplantation may be considered necessary in selected patients. The prognosis ranges from complete recovery to progression of disease.4 Conflict of interest: None declared.
Photographs and text from: D. Aktuerk, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK; M. Lutz, Department of Internal Medicine A, University Hospital of Mu¨nster, Mu¨nster, Germany; D. Rosewarne, Department of Radiology, New Cross Hospital, Wolverhampton, UK; H. Luckraz, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK. email: [email protected]
Figure 1. (a, b) CT images of the lung in a 52-year-old woman showing multiple cavitary nodules (arrows) representing the so-called ‘Cheerios’.
C The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. V
All rights reserved. For Permissions, please email: [email protected]
743
Downloaded from by guest on November 17, 2015
A 52-year-old woman presented with a 3-month history of right pleuritic chest pain and recent night sweats. In terms of premedical history, she had a 30 pack-year smoking history but denied any environmental exposure. There was no evidence of tuberculosis exposure or a positive tuberculin test in the past. She denied weight loss and her travel history included visits only to European countries. Physical examination showed no evidence of jaundice, anaemia, cyanosis, clubbing or lymphadenopathy. On auscultation, the chest was clear with bilateral free air entry and there were no cardiac murmurs. A chest x-ray obtained on presentation was normal and did not show any lung pathology. A computed tomography (CT) scan revealed multiple cavitary nodules within the lung bilaterally especially in the right upper lobe. The so-called ‘Cheerios’ in the lung appear on CT images as one or multiple nodules of variable sizes with hypodense centres. Thus, they received their name after the ‘O’-shaped breakfast cereal ‘Cheerios’.1 They usually present as a small, hoop like and fairly uniform shadowing embedded in normal surrounding lung (Figure 1a and b, arrows). The ‘Cheerios’ in the lung have their origin in the peribronchiolar proliferation of malignant as well as non-malignant cells. Thus, the differential diagnosis includes bronchioloalveolar carcinoma, metastatic
744
|
QJM: An International Journal of Medicine, 2015, Vol. 108, No. 9
References 1. Reed SL, O’Neil KM. Cheerios in the chest. Chest 1993; 104: 1267–8. 2. O’Donovan PB. The radiologic appearance of lung cancer. Oncology 1997; 11:1387–402.
3. Chou SH, Kicska G, Kanne JP, Pipavath S. Cheerio sign. J Thorac Imaging 2013; 28:W4. 4. Abbott GF, Rosado-de-Christenson ML, Franks TJ, Galvin JR. From the archives of the AFIP: pulmonary Langerhans cell histiocytosis. Radiographics 2004; 24:821–41.
Downloaded from by guest on November 17, 2015
