Introduction
A never-smoking 82-year-old woman with a past medical history of type-2 diabetes presented to the outpatient clinic with a 3–4 months history of purulent bronchitis, haemoptysis, weight loss and fevers.
She had lived in a small village in India and Pakistan all her life and had been visiting the UK intermittently until setting up permanent residency a few months ago.
She denied any history of tuberculosis or any previous recent contacts.
Clinically, she had no lymphadenopathy and had bilateral crackles in the upper zones on auscultation. Her oxygen saturations were 98% on air.
Chest radiograph
Task 1
Interpret the chest radiograph (fig. 1)
Answer 1. The chest radiograph shows generalised nodularity with left upper lobe collapse and right middle lobe collapse. Crowding of the left upper ribs suggests long-standing volume loss.
A diagnosis of tuberculosis was entertained and sputum sent for analysis. A helical CT scan was also performed.
Computerised tomography images
Task 2
Please interpret her CT scans (fig. 2)
Answer 2. There is right middle lobe collapse with fluid-filled distal bronchi and patent origin of bronchus. There is marked volume loss and scarring in left upper lobe with fluid-filled bronchi and distorted left upper lobe bronchus, but also a larger low attenuation area on the left peri-hilar region. There are also numerous mainly peri-bronchovascular nodules in both lungs. There is also reduced lung attenuation in …
