What is the role of radiography in the workup of eosinophilic granuloma (histiocytosis X)?

Updated: Sep 11, 2020
  • Author: Eleanor M Summerhill, MD, FACP, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Chest radiographs in patients with pulmonary Langerhans cell histiocytosis X (PLCH) characteristically reveal bilateral, symmetric, ill-defined nodules and reticulonodular infiltrates. As the disease progresses, cystic lesions appear. An upper-zone predominance of radiographic findings with sparing of the costophrenic angles is typically observed, as follows:

  • Cystic lesions can be of various sizes and thin or thick walled.

  • Lung volume is normal or increased.

  • Honeycombing indicates advanced disease.

  • Bony lesions may occur on the ribs or any other site.

  • Hilar or mediastinal adenopathy is rare and should prompt the consideration of sarcoidosis or malignancy.

  • Pleural effusion is uncommon.

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