Case of the week 4.6.20
Publication Date: 2020-04-06
3 images
Findings
Orthogonal radiographs of the thorax
Multifocally, but most severely affecting the right middle and left cranial lung lobes, there is marked saccular/cystic dilation of the bronchi. This is resulting in a “honey-comb” or “cluster-of-grapes” like pattern with large clusters of gas-filled rounded structures with thin walls. The ventral and cranial margins of the lung lobes are retracted from the thoracic wall.
The right cranial lung lobe is hyperinflated and its cranial portion is hyperlucent and crosses midline towards the right. On the VD view, the left caudal lung lobe bronchus is dilated, and the right caudal lung lobe bronchus is ill-defined.
There is a moderate unstructured interstitial and bronchial pattern throughout the caudodorsal aspects of the caudal lung lobes.
There are pleural fissure lines on the left lateral view. There is a mild to moderate leftward mediastinal shift on the VD view.
The ventral aspects of the cardiac silhouette are ill-defined on the lateral views. The pulmonary vessels are largely obscured but have no overt abnormalities. There are multiple open physes, consistent with the patient’s young age.
Diagnosis
Severe multifocal saccular (also referred to as “cystic”) bronchiectasis with chronic retraction of the lung lobes. Given the age and history of the patient, this may be congenital, or could be secondary to chronic infectious disease (such as bacterial or parasitic pneumonia) or eosinophilic bronchopneumopathy.
Bronchiectasis can result in the patient being predisposed to recurrent infections. The appearance of the right cranial lung lobe is suspected to be compensatory. The appearance of the lung lobe margins is likely due to fibrosis and retraction due to the underlying pathology; however, a small amount of pleural effusion cannot be ruled out.
Notes
Case initially seen by Dr. Morandi
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