Welcome to Gray Matters, where we unpack how medical management is rarely black or white.

We go on deep dives along the way. I'm Jason Freed, a hematologist at Beth Israel Deaconess Medical Center.

And I'm Allie Traynor, a pulmonary and critical care physician at Mount Auburn Hospital.

And I have a case today that I've been ruminating on for a while that I'm really excited to discuss with you.

Let's do it. So this is a patient who first presented to pulmonary clinic in May of 2020, so four

years ago now. Oh, wow, you have been ruminating for a while. Yes. So at the time that I first met her,

she was seven years old, and she carried a history of asthma and was seeing pulmonary mainly for asthma,

but then also an incidental finding on a CT of her abdomen pelvis, which caught the lung

bases and showed some mild interstitial changes, which were read as concerning for early

interstitial lung disease or ILD versus chronic microasperation.

Uh-oh. I'm having flashbacks to our previous episode and incidental findings.

They get there so hard.

Yeah.

And, you know, especially when the read tells you, it could be acid reflux or it could be

interstitial lung disease.

That is a huge difference.

Yeah.

I feel like I see this in radiology reports pretty often.

Like, I get a CT for another reason.

Patient has no pulmonary symptoms. And then the radiology reads as fine subplural reticulations at the lung bases,

which could be atalectocysts, aspiration, or early interstitial lung disease.

So maybe we can do this for our first deep dive.

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