Presentation
Previous history of left upper lobe resection of aspergilloma. Nature of lesions in the right lung?
Patient Data
Evidence of the previous thoracoplasty with left upper lobe resection.
Ovoid densities in the right middle lobe with a finger-in-glove type appearance suspicious for mucus plugging of dilated bronchi, a finding of allergic bronchopulmonary aspergillosis.
The remainder of the lungs is clear.
No pleural effusion.
Non contrast scans were performed through the chest.
Direct comparison is made to previous CT chest performed. Left upper lobectomy noted.
Bronchiectasis and bronchiolectasis of the right middle lobe, anterior basal segment of the right lower lobe and apical segment of the left lower lobe.
The previously described 1.2 cm subpleural nodule in the left lower lobe apical segment has morphology that is more consistent with scarring when reviewed on multiplanar reformats.
Multiple calcified granulomas within the right lung and areas of minor subpleural scarring.
Some architectural distortion of the left lower lobe anteriorly.
Calcified mediastinal lymph nodes consistent with previous granulomatous disease.
Conclusion
Overall appearances in the left lower lobe apical segment is most likely secondary to scarring from previous infection.
Case Discussion
This patient had a past history of pulmonary TB, later complicated by aspergilloma formation in the left upper lobe.
Recurrent hemoptysis lead to a left upper lobectomy.
The calcified lesions in the right lung are old tuberculous broncholiths (broncholithiasis)