Presentation
Chronic non-productive cough.
Patient Data
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Linear opacities in lingula and anterior segment of RUL, better seen in lateral view.
Subsegmental atelectasis are seen in anterior segment of right upper lobe and lingula. Bronchiectasis in RUL, middle lobe and lingula are also noted, some of them with mucosal impactions and showing a 'tree-in-bud' pattern.
Bronchoalveolar lavage (BAL) culture confirmed the presence of Mycobacterium avium intracellulare.
After antibiotic treatment the patient presented improvement of symptoms, although residual subsegmental atelectasis persisted.
Case Discussion
In elderly female patients with the presence of chronic cough together with atelectasis and bronchiectasis in the middle lobe or lingula (as seen in this case), the diagnosis of chronic infection by atypical mycobacteria (M. avium complex) should be suspected, being this finding classically known as Lady Windermere syndrome.
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