Pulmonary Mycobacterium avium complex infection

Case contributed by Bruno Di Muzio
Diagnosis almost certain


Chronic productive cough.

Patient Data

Age: 75 years
Gender: Female

Chest radiographs


Patchy nodular opacities scattered thought both upper lobes, lingular region, and right middle lobe. Lucencies in both upper lobes may represent emphysematous changes. No pulmonary consolidation or pleural effusions. Cardiomediastinal contours are normal. Thoracic bony cage is unremarkable.  

Bronchiectasis, bronchial wall thickening, centrilobular nodules in a tree in bud appearance, and mucous plugging are noted scattered through both upper lobes, right middle lobe, and superior segments of the lower lobes. Pleural scarring in both apex. Centrilobular emphysematous changes. 

Case Discussion

This case shows typical features to suggest MAC: subacute/chronic history, elderly female patient, centrilobular nodules, bronchiectasis, and mucus plugging with the involvement of the lingular segments and right middle lobe. TB would be a differential, but it usually does not have bronchiectasis in this distribution as a feature. 

Mycobacterium avium complex was isolated. 

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