PMC5991906_01
Posterior-anterior (PA) chest radiograph.
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Posterior-anterior and lateral chest radiographs demonstrated reticular thickening at the right major fissure and are shown in Fig. 1, Fig. 2.
Non-contrast computed tomography of the chest.
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A non-contrast computed tomography (CT) scan (Fig. 3) demonstrated multiple sub-centimeter nodules, right middle lobe and lingular segmental bronchial narrowing with bibasilar atelectasis and mild interlobular septal thickening.
Contrast-enhanced computed tomography of the chest.
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A contrast-enhanced chest CT (Fig. 4) followed which further demonstrated distinct, enlarged mediastinal adenopathy.
Airway anthracosis viewed with bronchoscope.
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She underwent elective bronchoscopy, which showed diffuse airway mucosal hyperpigmentation and right upper lobe multi-segmental narrowing, right middle lobe medial segmental narrowing and lingular multi-segmental narrowing (Fig. 5).
Lymph node fine-needle aspirate demonstrating black pigment.
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Sampling revealed necrotic tissue with black anthracotic pigment both grossly and microscopically (Fig. 6).