Right upper lobe infective changes

Case contributed by Dr Wayland Wang

Presentation

Septic and tachypnoeic. Background of a chronic granulomatous disease with non-functioning neutrophils.

Patient Data

Age: 20
Gender: Male
X-ray
Patchy changes in the right midzone like reflect infective infiltrate in this clinical context. No other significant change since the previous chest x-ray.
CT

CT chest from later the same day

There are multiple pulmonary nodules in the anteroinferior aspect of the right upper lobe, with a more confluent area of consolidation peripherally in the right upper lobe abutting the oblique fissure. Several of the nodules demonstrate adjacent ground-glass opacification. There is associated peribronchial thickening. No bronchiectasis. Streaky opacity in the medial segment right middle lobe, posterior basal segment right lower lobe and apicoposterior segment left upper lobe have been demonstrated previously and likely represent chronic atelectasis/scarring. Patchy right middle lobe and bilateral lower lobe lucent areas are also unchanged. A single borderline enlarged right paratracheal lymph node is noted, measuring 11 x 12 mm. No hilar lymph node enlargement. Incidentally noted arch origin of the left vertebral artery. Right posterolateral chest wall defect is unchanged. Within the limitations of this study, the visualised upper abdominal viscera are unremarkable. No destructive osseous lesion.

Conclusion:

Right upper lobe pulmonary nodules, some with associated ground-glass opacities, and a more focal area of consolidation laterally are most in keeping with an infective process. Although there are no specific features to suggest a fungal infection, this cannot be excluded in the setting of immunosuppression.
 

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Case information

rID: 50755
Case created: 20th Jan 2017
Last edited: 21st Jan 2017
System: Chest
Inclusion in quiz mode: Included

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