Muppet is very excited because he has seen many interesting cases in the last two months. He has decided to show them during December and January to make me jealous.
The first patient is a 42-year-old woman with a moderate cough, seen on the 19th of November. What would be your diagnosis? Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.
Findings: PA film shows a branching shadow in the right lower lung (A, arrow).
There is also hyperlucency of the left lung with slight mediastinal shift. The combination of hyperlucent lung plus a branching shadow is highly suggestive of mucus impaction and secondary air trapping.
CT confirms the mucus plug (C,D arrows) and the hyperlucency involving the whole left upper lobe, including the lingula (E,F asterisks).
For those of you that diagnosed AVM, remember that this malformation is not accompanied by lung changes.
Final diagnosis: congenital bronchial atresia.
Congratulations to Fernando, who made the right diagnosis
Teaching point: focal hyperlucent lung and mucus impaction are very suggestive of bronchial atresia. In my experience, it one of the most common congenital malformations in the adult. I saw this case only three weeks ago.
