Mental Status Changes

History 52 y o female presented to the ED with mental status changes Bradycardia noted in ED

Chest Radiograph

Chest CT

History Lifelong nonsmoker Maternal history of emphysema ◦ Smoker Chronic daily cough No hemoptysis SOB with exertion No toxic exposure

Lymphangioleiomyomatosis (LAM) Proliferation of pulmonary interstitial smooth muscle and cyst formation ◦ Infiltration into lung parenchyma, lymphatics, airways and blood vessels Lungs are large and diffusely cystic Often misdiagnosed as asthma or COPD Most common presenting symptoms: ◦ Dyspnea ◦ Pneumothorax Gross specimen demonstrating cystic changes

Lymphangioleiomyomatosis (LAM) Progressive disease, no treatment is curative Median survival is 8-10 years from time of diagnosis Female predominance ◦ Usually occurs during the reproductive years Pregnancy and HRT accelerate the disease