PMC9763604_01
(A) 3D-VR image shows a mass lesion (star) in the left upper lobe; (B) coronal Minimum intensity projection (MinIP) indicates some air bronchus signs (black arrow); (C-E) axial and lateral contrast-enhanced CT thorax scan shows a large soft tissue density mass (star) in the left upper region, measuring 6.5 cm x 8.5 cm x 7 cm in size, with moderate heterogeneous enhancement. The mass invades the adjacent rib (triangle, left 2nd and 3rd rib) and chest wall soft tissues, and an associated pleural effusion is observed medial to the left crus of the diaphragm (white arrow); (F) 3D-VR image demonstrates bony destruction with periosteal reaction in left 2nd and 3rd ribs (white arrow); (G) T2-weighted image demonstrates the left upper lobe presenting as hyperintensity with air bronchogram sign, involving the pleura and muscles of the anterior chest wall; (H,I) Pathological findings suggest septic inflammatory changes in the lesion tissue, and show actinomycotic granules with a basophilic center containing bacteria colonies (star) with eosinophilic periphery composed of Splendore-Hoeppli material (white arrow) (PAS stain, PAS-D stain, 1,000x); (J) Following antibiotic treatment for 2 months, chest radiograph shows most of the lesion having been absorbed.
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F1
The patient underwent a detailed series of radiological examinations to visualize the entire landscape of the lesion. 3D-VR imaging and MinIP showed the mass and its internal structures (Figures 1A,B). There were some bony invasions of the left 2nd and 3rd ribs and an associated left pleural effusion (Figures 1C,G). However, pathological biopsy via the chest wall suggested purulent inflammation with scattered bacterial clusters, which morphologically suggested Actinomyces species (Figures 1H,I). At 2-month outpatient follow-up, the patient had completely recovered, with no symptoms remaining, and chest radiograph showed that most of the lesion was absorbed (Figure 1J).