Case 1
A 53 year-old female with poorly controlled asthma presents with wheezing, productive cough and a peripheral eosinophilia. A chest radiograph is taken.
1. What is the main abnormality?
a) Lobar collapse
b) Pulmonary fibrosis
c) Bronchiectasis
d) Reticulonodular shadowing
e) Pleural plaques
2. Given the radiographic findings, what would you consider as an underlying diagnosis?
a) Asbestosis
b) Invasive aspergillosis
c) Eosinophilic pneumonia
d) Allergic bronchopulmonary aspergillosis (ABPA)
e) Lung cancer
Case 2
A 47 year-old female presents with ongoing shortness of breath.
1. What is the main abnormality present on the chest radiograph?
a) Right lung collapse
b) Right pleural effusion
c) Bronchopleural fistula
d) Right pneumonectomy
e) Right lower lobe consolidation
Answers
Case 1
1. c) Bronchiectasis. The main abnormality is the presence of thickened non-tapering bronchial walls (yellow arrows on the figure), which can have the appearance of tram lines and clustered walled cystic spaces (blue arrows). These findings are in keeping with bronchiectasis. In this case the distribution is predominantly central.
2. d) Allergic bronchopulmonary aspergillosis (ABPA). The patient had elevated Aspergillus specific IgE levels and peripheral eosinophilia and was diagnosed with ABPA, with confirmation of central bronchiectasis on …