José Vilar and Friends Case 34 (Update: Solution)

Dear Friends,

This case was provided to me by Dr Maria Luisa Domingo ( Hospital Universitario Dr Peset).

A man 76 years old with cough and chronic respiratory problems.
Non contrast CT.

Let me see what you think.

Ok Marcos Mestas, here is another image. You should make the diagnosis…

 

Click here for the answer

The sagital image that I sent to you last Thursday demonstrates calcifications (red arrows) within the “consolidation” that ,in this projection, now it appears more tubular in shape ( Drawing in red)..

Therefore we have:

  1. Bronchiectasis
  2. Long standing history of respiratory disease
  3. Dilated bronchi with calcium within them

These are very characteristic findings of Allergic Bronchopulmonary Aspergillosis (ABPA). As was very well put by one of you.

The radiographic findings in these patients. Often with asthma are:

Chest Radiograph: May be normal or show fleeting consolidations especially in upper lobes and bronchiectasis with bronchi filled with mucus ( Finger in glove sign similar to the one I showed in Case 13).

CT:

  • Pulmonary opacities
  • Dilated bronchi with thick walls and with inspisated mucus and calcifications in 30% of the cases
  • Cetrialobular nodules.

Teaching point: Dilated bronchi with inspisated mucus and calcification is a a very good sign of ABPA.

Calcification within a bronchus may also be due to a foreign body, broncholith (usually denser and more localized) or tumours that contain calcium (carcinoid, hamartoma and very rarely lung cancer).

  
 

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    6 Responses to : José Vilar and Friends Case 34 (Update: Solution)

    1. Marcos Mestas says:
      October 5, 2020 at 20:36

      Se ve una consolidacion en lobulo superior izquierdo que respeta la cisura con una imagen tubular adyacente (vaso? bronquio ocupado?)
      Abajo se ve una bronquiectasia varicosa del lado derecho.
      No llego a darme cuenta si hay pequeños nódulos en vidrio esmerilado.
      Más imágenes?

    2. Dr. K.Kanakaraj says:
      October 7, 2020 at 06:07

      left hilar prominance–hilar mass / adenopathy
      collapse consolidation of apico posterior segment of left upper lobe with bronchictatic changes.
      ant mediastinal fat
      small pre tracheal nodes
      ? minor fissure in left side–bilateral right sidedness in asplenia
      right middle lobe bronchictatic changes involving lateral segment

    3. Raj says:
      October 7, 2020 at 12:07

      ABPA high density mucous sign.

    4. Dr.K.Kanakaraj says:
      October 8, 2020 at 07:35

      coronal view suggest left upper lobe bronchial cut off, with upper lobe collapse

    5. Hrvoje says:
      October 8, 2020 at 07:44

      Bronchiectasis and abpa, ddx mesothelioma.

    6. Marcos Mestas says:
      October 14, 2020 at 15:13

      Llegué tarde y no me llegan avisos al mail. Muy bueno!