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Initial posteroanterior chest radiograph performed at another hospital showing multifocal consolidations and ground-glass opacities in both mid and lower lung zones (arrows).
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An outside posteroanterior chest radiograph performed 3 weeks before showed multiple consolidations and ground-glass opacities in both the mid and lower lung zones (Fig. 1).
A subsequent chest CT shows multiple nodules and masses with internal cavitation in both lungs. Pulmonary thromboembolism and pleural effusion were not observed; however, reticulation and ground-glass opacities with traction bronchiectasis were detected in the posterior basal segment of the right lower lobe (arrows).
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A subsequent chest CT scan showed multiple pulmonary nodules and masses with internal cavitation in both lungs (Fig. 2).
A. Ultrasound-guided percutaneous needle biopsy of the mass in the right lower lobe.. B. Corresponding microscopic features (hematoxylin and eosin stain, x200) showed a peripheral rim of granuloma (arrows) and Langerhans giant cells (arrowheads) surrounding the inflammatory cells, including neutrophils (black asterisk). Alveolar septa thickened by the inflammatory cell infiltration and mild interstitial fibrosis with distortion of lung architecture (yellow asterisk).
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An ultrasound-guided percutaneous needle biopsy of the mass in the right lower revealed a chronic granulomatous inflammation, inflammatory cell infiltration, and distortion of the lung architecture (Fig. 3).
A posteroanterior chest radiograph after anti-mycobacterial treatment.. Multiple consolidations and ground-glass opacities were improved. Reticular opacities were noted in both lower lung zones (arrows).
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Following treatment with anti-mycobacterial medications (ethambutol, rifampicin, and azithromycin), her symptoms and radiological findings greatly improved (Fig. 4).
Follow-up chest CT performed after 2 years of anti-mycobacterial treatment shows improvement in multiple nodules and masses in both lungs. The underlying lung parenchyma revealed subpleural reticulation with traction bronchiectasis in both lungs with basal and peripheral predominance.
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Furthermore, it showed a predominant lower lobe pulmonary fibrosis with mild ground-glass opacity, reticulation, and traction bronchiectasis that was not identified on the initial chest CT (Fig. 5).