Bilateral Lower Zone Shadows On Chest Radiograph - A Clinicopathological Profile

摘要

Background: The initial suspected diagnosis in bilateral lower zone lung involvement made clinically can becompared and correlated with the final diagnosis obtained after percutaneous FNA cytology, BAL fluid examinationand transbronchial biopsy.Aim: To study diseases presenting with bilateral lower zone shadow on chest radiograph and compare the initialclinical diagnosis to the final diagnosis.Methods: Fifty six patients were studied by routine hematological, sputum and pleural fluid examination alongwith PCNA and TBNA cytology, bronchial aspirate/ BAL fluid examination and transbronchial biopsy after adetailed clinical history and thorough physical examination.Results: Initially suspected diagnosis included tuberculosis in 32.1% cases, pneumonia in 30.4%, malignancy in10.7%, pulmonary oedema in 5.4%, bronchiectasis in 8.9%, ILD in 7.1%, TPE in 3.6% and bilateral hydatiddisease of lung in 1.7% of cases. The final diagnosis revealed tuberculosis in 25.0% cases, pneumonia in 23.2%,malignancy in 16.1%, bronchiectasis in 8.9%, pulmonary oedema and ILD in 7.1% each, sarcoidosis and TPE in3.6% each, while pulmonary candidiasis, pulmonary alveolar proteinosis and bilateral hydatid disease of the lungin 1.7% case each respectively.Conclusion: Majority of cases can be diagnosed by a detailed clinical profile along with a chest radiograph.However, FNAC and fibreoptic bronchoscopy are of high value for pathological and microbiological confirmationof the diagnosis and provides a significant yield.