Right upper lobe collapse

Presentation

Persistent cough post chemotherapy. Past history diffuse large B-cell lymphoma.

Patient Data

Age: 90
Gender: Male
X-ray

Initial CXR

Almost complete collapse of the right upper lobe.

CT

CT Chest

Right upper lobe collapse with mucus plugging in the right upper lobe bronchus and its branches. There is no evidence of invasion into the pulmonary vessels. The previously demonstrated right lower lobe nodule is more pronounced with adjacent atelectasis and patchy ground glass opacity. Further non obstructive mucus plugging is seen within the left upper lobe bronchus. There is left basal band atelectasis.

Patient went on to have a bronchoscopy. Results of bronchoscopy shown below:

Histology

RUL sputum plug: Plug right upper lobe of lung: Mucous plug with eosinophilia and fungal hyphae, raising the possibility of asthma/allergic bronchopulmonary aspergillosis

Bronchial washings: Eosinophilia with fungal elements identified

Fungal Culture: Aspergillus fumigatus ISOLATED

X-ray

Post bronchoscopy CXR

The previously noted collapse and consolidation of the right upper lobe has considerably improved. Significant lung volume loss persists, however, there is good aeration now of segments of the apical anterior and posterior segments of the right upper lobe.

Case Discussion

Typical appearance of RUL collapse.

Aspergillus is a common organism and does not necessarily imply pathology. In this case, the possibility of ABPA was raised, however, in the absence of bronchiectasis or a history of asthma-like symptoms, this is unlikely. 

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Case information

rID: 21784
Case created: 18th Feb 2013
Last edited: 25th Mar 2017
System: Chest
Inclusion in quiz mode: Included

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