Thank you! It was a fun lecture!

I didn't know that. Thank you

Hi, it depends on how sensitive and specific you want to be. I would definitely do a CT in a female with recurrent pneumothorax or bilateral pneumothorax without known cause. And also would probably do it in hydropneumothorax. I think doing CT on the first pneumothorax is still reasonable but the practitioner should realize that the number of cases that will be positive for LAM is low. Yes spontaneous pneumothorax is uncommon, rare might be too strong of a word.

Great questions. For emphysema, the distribution is upper lung predominant. Also the holes in emphysema should not have perceptible walls and there are frequently small vessels running through them. But you're right, in cases of advanced LAM in smokers, it can be difficult to tell and in fact both can coexist.

The European Respiratory Society addressed the number of cysts question. They said it was characteristic of LAM if there are more than 10 cysts and no other lung findings that could explain them. And if it is 2-10 cysts, it could be compatible with LAM but only if you have other evidence (VEG-F, AMLs, lymphangioleiomyomas, positive path, etc.). Yeah i think you're right, most likely your case was from pneumatoceles from COVID, particularly if it was a more severe case.

Good question. I think if you came across a patient with the lymphangiomas, perhaps lymphoma would be in your differential on first glance. But they do behave differently from enlarged nodes or nodal conglomerates. One of the biggest differences in my mind is that they can change throughout the day or with positioning. I have a case where the patient is supine and they are large and on prone they get smaller.

Interesting theory but endometriosis in the chest is super rare. It is nowhere near 25%. AML in the kidney alone is not sufficient. The criteria requires more than that.

@@ThoracicRadiology from the cited paper: "it is still considered relatively rare although accounting for 20-35% of spontaneous pneumothoraces occurring in premenopausal women" At issue is ageism. It is a very frequent cause for pneumothorax in child bearing age women. Which is only a small portion of the pneumothorax population since most are geriatrics. But it is clearly incorrect to apply geriatric diagnostics when a patient doesn't fall in that category and the statistics are so different for old vs young such as in spontaneous pneumothorax. Finally, endometriosis is extremely common in women, while LAM is a super rare genetic disease (which inconveniently is impossible to genetically confirm because it is not possible to gauge if any given mutation in this huge gene would render it disfunctional, apart from some known mutations). So seems clear to me which is going to be more indicative in pneumothorax.

If you have cysts in the lung, they won't go away but there are medications you can take to slow the disease. Best to see a lung doc who has some experience in this area. Thx.

@@ThoracicRadiology i had done vats operation in 2020 and after that i am suffering from breathless problem,, and its related to alaric problem.. I use oxygen. Plz can you tell sir what is the medication?

Hi from you? I also suffering this lam desease pls share your experience what should we do? I can't afford expensive medical care Pls tell me how many years l can survive this desease pls reply

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Lymphangioleiomyoma will have a diurnal variation as opposed to the other processes.

Sorry to hear that. I'm not sure what's causing the wavering of symptoms. If you are on treatment, usually it is either stable or slowly progressive. Maybe the symptoms have more to do with smoking? Not sure. Probably best to talk to your lung doc about it.

not always, sometimes a cyst with an eccentric vessel is just a cyst. This is a classic description of the cysts in LIP. If it looks like it is connecting with the rest of the bronchi, then it is bronchiectasis.

@@ThoracicRadiology thank you 😀