PMC4531673_01
A 69-year-old man with pulmonary actinomycosis induced by fish bone. Chest radiograph shows ill-defined increased opacity and atelectatic change (arrow) in the left upper lung zone.
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Chest radiographs revealed increased opacity and atelectatic change in the anterior segment of the left upper lobe, suggestive of obstructive pneumonitis or pulmonary tuberculosis (Figure 1A). A computed tomographic scan (CT) of the thorax showed consolidation and air bronchogram in the left upper lobe with partial atelectasis, but significant enlargement of mediastinal or hilar lymph node was not observed (Figure 1B).
A chest CT scan obtained at the level of the aortic arch reveals consolidation with airbronchogram (arrow) in the left upper lobe. Fish bone was not identified in the CT scan.
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Bronchoscopic examination showed a pink and soft protruding mass obstructing the left upper lobar bronchus was suggestive of bronchogenic carcinoma (Figure 2A). Follow-up bronchoscopic examination revealed a complete resolution of the endobronchial mass lesion and, in place, a foreign body was exposed (Figure 2B).
This fiberoptic bronchoscopic finding show a soft tissue mass in the left upper lobar bronchus
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However, biopsy of the lung tissue obtained by bronchoscopy showed gram-positive sulfur granules and hyphe-like components within a granulomatous formation, which showed squamous metaplasia of bronchial mucosa with mixed inflammatory cellular infiltration and some colonies of actinomycosis (Figure 3).