Essay 6: Centrilobular/peribronchiolar distribution

Essay 6: Centrilobular/peribronchiolar distribution

Essay 6: Centrilobular/peribronchiolar distribution

Question 1:

Mr. G is a 74-year-old male with no significant past respiratory history except for “asthma” presented to the chest clinic for preoperative clearance for a cholecystectomy. He had a 7-year history of episodic cough productive of white to yellow phlegm, which cleared with antibiotics, but was recurring at more frequent intervals. The cough had been constant for several months at the time of presentation. He also complained of progressive dyspnea on exertion over the same period such that she could now walk only about 4 blocks. He does not smoke cigarettes. He is a retired builder and sandblasts classic cars in his garage as a hobby. Physical examination was remarkable for an increased second pulmonic sound and jugular venous distension. Lungs had rare rales and rhonchi. No clubbing was noted.

A CT of the upper lungs (B) in 3/98 shows multiple round and irregularly-shaped small nodules, many of which appear to be in a centrilobular/peribronchiolar distribution. A large, irregularly-shaped mass on the right appears to be a conglomerate of small nodules.

1. Discuss the differential diagnosis.

2. What is the most likely diagnosis?

3. Explain the pathophysiology.


You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.