Radiographic changes: The frontal film (left) was remarkable only for possible hazy density of the left mid and lower chest. The lateral film showed an important abnormality. What is it? Answer

CT: An image (lung windows) obtained at the level of the left upper lobe bronchus demonstrates a finely nodular pattern of densities in and around the bronchi of the left upper lobe. What is the pattern of the fine nodules, and what do they signify? Answer

Compare the position of the left and right interlobar fissures and note that the left is positioned anteriorly, confirming the chest radiographic findings.

The mediastinal window at the same level demonstrates filling of the lumen of the left upper lobe bronchus with low attenuation material, possibly mucus. No density greater than water density is seen to suggest an endobronchial tumor. If there is a sizable tumor (1 cm or greater), it would have to be of water density or lower. This could occur with a necrotic or fatty tumor. Therefore, it was concluded that if there was an obstructing tumor, it was likely a very small one.

A bronchoscopy was performed.

Clinical summary Bronchoscopy Image 1

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Answer: The left interlobar fissure is displaced anteriorly, indicating partial collapse of the left upper lobe. A mild, hazy, lingular infiltrate makes the fissure visible as a sharp, linear edge at the posterior border of the faintly-consolidated left upper lobe.

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Answer: These are centrilobular nodules with a tree-in-bud pattern consistent with bronchiolar inflammation. (See also Case 10. Use the "back" button to return to this page.)

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