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Multiple pulmonary nodules: diagnosis in an young afebrile patient
  1. K S Sodhi,
  2. M Kang,
  3. M Gulati,
  4. S Suri
  1. Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to:
 Dr Kushaljit Singh Sodhi, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh-160012, India;

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Answers on p 64.

A 22 year old women presented with complaints of vague pain in the chest for three months and cough with expectoration for six days before admission. On examination, she was afebrile and non-dyspnoeic. Her pulse rate, respiration rate, and blood pressure were within normal limits. Her white cell count was only mildly raised. She had a normal haemoglobin concentration and erythrocyte sedimentation rate. Mantoux test was negative.

Chest radiography (fig 1) and computed tomography (fig 2) showed bilateral, multiple, well defined lung parenchymal nodules, randomly distributed throughout both lung fields. An air crescent was also seen in one of the nodules in the right lower lobe (fig 2B). Casoni’s test was done later, which was positive. No mediastinal or hilar lymphadenopathy and no pleural or pericardial effusion was seen.

Figure 1

Chest radiograph of patient.

Figure 2

(A) Computed tomogram showing multiple pulmonary nodules. (B) Crescent sign is seen in the right lower lobe nodule.


  1. What is the diagnosis?

  2. What is the differential diagnosis?

  3. How does this condition present?

  4. What other tests should be performed?

  5. What is the pathogenesis of the crescent sign?

  6. What are other causes of the crescent sign?

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