Presentation
Chest pain. Current smoker.
Patient Data
Right upper lobe anterior segment area of consolidation.
Consolidation of the anterior segment of the right upper lobe. Note is made to the pruning of the anterior segment of the bronchus of the RUL, but no discrete mass. The lungs and pleural spaces are otherwise clear.
The patient underwent a bronchoscopy.
Clinical Notes: RUL obstruction. Segment RB3 RUL.
Macroscopy: Transbronchial biopsies - multiple pieces of tissue up to 2mm.
Microscopy: Sections comprise neutrophils admixed with sloughed respiratory epithelium and fragment of acutely inflamed respiratory epithelium with subepithelial oedema and reactive endothelial cells and acute and chronic inflammatory cell response with focal areas of subepithelial calcification associated with foreign body giant cell response. Seromucinous glands are seen however there is no evidence of malignancy.
Diagnosis: Features of acute bronchitis. Subepithelial calcification? dystrophic. No malignancy in these sections.
There has been an improvement with a partial clearance of the RUL consolidation. The lungs and pleural spaces are otherwise clear.
Resolution of the consolidation with residual bronchiectasis/band of atelectasis.
Scarring related to the previous lobar pneumonia and characterised by a focal volume loss and traction bronchiectasis in the anterior segment of the RUL.
Case Discussion
This case brings the journey through the concerns and the follow-up of right upper lobe pneumonia in a smoker patient. Long term follow-up images illustrate the scarring and traction bronchiectasis as a sequela of this process.
The clinical presentation and laboratory at the time, added to the risk factors for malignancy, guided the respiratory physicians to perform a bronchoscopy to asses eventual underlying malignancy.
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