CT
CT confirms a left pulmonary pseudotumour with encysted heterogeneous pleural fluid orientated along the left oblique fissure with tapered ends (maximum HU-20). Multiplanar reconstructions assist in making this diagnosis in the absence of a lateral chest view while the patient is in a high-care setting. There are bibasal effusions with atelectasis.
There are hyperinflated lung fields consistent with known COPD, centrilobular and paraseptal emphysema, and pulmonary arterial hypertension.
There is bi-apical bronchovascular distortion, cicatricial emphysema, and right upper lobe chronic granulomas consistent with previous pulmonary tuberculosis. There are calcified left prevertebral and left hilar lymph nodes.
Previous imaging confirmed a tree-in-bud appearance within the right middle lobe and bilateral lower lobes consistent with recurrent/re-infection of pulmonary tuberculosis. The patient was on tuberculosis treatment at the time of this study.
There is a tracheostomy in situ. There are dense secretions/ blood inferior to the tracheostomy in view of the ongoing heamoptysis.
Image courtesy of Dr. K Kobo.