Today I’m showing chest radiographs of a 50-year-old woman with cough and sputum production.
What do you see?
You will have more images on Wednesday.
showing today CT images of the patient. What do you see?
Click here to see the answer
Findings: PA chest shows a small right lung, with a triangular opacity occupying the lower lung (A, arrow). The right heart border is not seen. The trachea and mediastinum are displaced to the right. In the lateral view the lower opacity occupies the lower lung from front to back (B, arrows).
This appearance is typical of combined RLL and RML collapse (obliteration of right heart border) and the most likely diagnosis is an obstructing lesion in the intermediary bronchus.
Enhanced axial CT shows marked narrowing of the intermediary bronchus (C, arrow). A caudal image shows marked dilatation of mucous-filled bronchi (D, arrows). This appearance indicates a long-standing obstruction and goes against a malignant process
Comparison with a previous radiograph (F) shows that the chest has not changed in comparison with the recent one (E). Bronchoscopy performed three years earlier demonstrated chronic stenosis of intermediate bronchus secondary to previous TB
Final diagnosis: Chronic TB changes of intermediary bronchus causing collapse of RML and RLL.
Congratulations to Maged Shaban and Yelgha who made the correct diagnosis of RLL and RML collapse
Teaching point: remember that central lobar collapse with bronchiectasis is rarely caused by malignancy.