PMC5402628_01
Chest radiographs taken at the first medical examination (left) and three months after discharge (right). The first radiograph shows left pleural effusion and consolidation in the left upper lung. The second, however, shows unilateral expansion of the consolidation.
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The patient was admitted with a diagnosis of complicated effusion and underwent chest tube insertion into the left thoracic cavity (Fig.1). Three months after discharge, the consolidation in the left upper lung had worsened (Fig.1)and we again tried to investigate its etiology.
Computed tomographic images with 1-mm collimation three months after discharge. The previously existing consolidation in the left upper lung has worsened, expanding particularly in apicoposterior segment of left upper lobe. A cavitary lesion has also developed.
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The previously existing consolidation in the left upper lung had worsened on chest CT, showing marked expansion in the left B1/2 (Fig.2), and the left plural effusion had decreased.
Histopathological view of transbronchial biopsy specimens obtained from the left lung. Hematoxylin-eosin stain (left; original magnification, x200) shows a mass of bacteria in the center with neutrophil infiltration, and a Grocott stain of the specimen (right; original magnification, x200) shows filamentous bacteria.
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The biopsy specimen from the left B1/2 showed a mass of bacteria in the center with neutrophil infiltration, which was a round basophilic mass with a radiating arrangement of eosinophilic clubs on the surface (Fig.3).