Today's Daily Diff is
bilateral upper lung disease. When evaluating chest x-rays, this pattern of disease is fairly common. Having a handy list of possible diagnosis can help you narrow down possible etiologies when framed in an appropriate clinical context. One handy mnemonic to help remember this differential is
CASSETTE PRR:
| Disease | Notes |
C | Cystic fibrosis | |
A | Ankylosing spondylitis | |
S | Sarcoidosis | |
S | Silicosis | |
E | Eosinophilic granuloma / Langerhans cell histiocytosis | Young male smokers |
T | Tuberculosis | |
T | Tumors (metastases) | |
E | Everything else | |
| |
P | Pneumocystis Pneumonia (PCP) | Immunocompromised |
R | Radiation fibrosis | Head and neck cancers |
R | Rheumatoid lung | |
In general, keep in mind that the upper lung zones have increased aeration and decreased perfusion relative to the lower lung zones due to the effects of gravity.
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