PMC6812348_01
Bilateral lung lesions and central cavitation. Axial CT images with lung window settings shows multiple bilateral lung lesions, some demonstrating central cavitation.
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Fig. 1 presents a computed tomography (CT) scan of the chest at the time of initial presentation which showed multiple bilateral mass-like lesions measuring up to 5cm, some demonstrating central necrosis and cavitation with thick and irregular walls.
2a and 2b. Erythema and edema with abnormal airway mucosa. Bronchoscopy demonstrating abnormal airway mucosa with erythema and edema in the right upper lobe (A) and left mainstem bronchus (B).
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Basophilic necrosis of an endobronchial biopsy. Endobronchial biopsy showing multinucleated giant cell (arrow) surrounding an area of basophilic necrosis with neutrophils (arrow heads) - Hematoxilin and eosin stain.
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Biopsies demonstrated large areas of neutrophilic necrosis (so called "basophilic necrosis"), granulomatous inflammation with multi-nucleated giant cells, mucosal ulceration, and squamous metaplasia (Fig. 3).
Pneumothorax with small pleural effusion from a chest radiograph. Posteroanterior chest radiograph demonstrates a large right pneumothorax with small pleural effusion. There are parenchymal abnormalities in the right upper lobe and left perihilar lesion corresponding to residual lesions seen in previous CT.
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An urgent chest radiograph revealed a large right sided loculated pneumothorax with small fluid component (Fig. 4).
Large cavity lung lesions and right pneumothorax. A, Axial CT scan demonstrates the large cavitary lesion in the right lung with direct communication with a segmental right upper lobe bronchus (arrow). B, Coronal reformat demonstrates large cavitary lung lesion and right pneumothorax (asterisk).
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A chest CT was performed, demonstrating enlargement of two pre-existing pulmonary cavities with air fluid levels, open communication with an adjacent bronchus, and hydropneumothorax (Fig. 5). The remaining pulmonary lesions demonstrated improvement when compared with previous imaging (Fig. 5).