• Rheumatoid arthritis
• SLE
• Kartageners

• persistence of airflow obstruction
• borderline restrictive disease
• mild decrease in diffusion capacity

• On steroids

CT 7 years ago

Mild Middle Lobe Reticular Changes

Calcification associated with Cyst in the Lower Lobe

Subsegmental infiltrate around the Bronchovascular bundles in the Right Lower Lobe 7 years ago

Lymphadenopathy 7 years ago

1 Year Ago

Progressive Lingular Reticular Changes and Perhaps Tree in Bud?

Stable Calcification and a Cyst

 Current

Cystic Changes Stable

Cysts Associated with Blood Vessels

Persistent Decreased Adenopathy ? Early Calcification

RLL Infiltrate Progressive Peribronchial Changes

Lingular Changes of Nodules and Mild Reticular Change ? Improved

Stable Calcification and a Cyst

• cysts bilaterally, with
• lower lobe predominance,
  • up to 4.1 cm
  • slightly dysmorphic in shape,
  • some simple and
  • some multiseptated,
  • not significantly changed since 4 years prior , but progressed over 7 yearsDifferential Diagnosis
    • Birt-Hogg-Dube syndrome.
    • Atypical LIP (lymphocytic interstitial pneumonitis) In the context of a
      known negative FCLN gene mutation and an established diagnosis of
      Sjogren’s syndrome, this could represent an atypical presentation of
      lymphocytic interstitial pneumonitis.