PMC9196837_01
Chest CT and x-ray during first admission to Pulmonary Department. Chest x-ray depicting right upper lobe (RUL) cavity, retractile findings, and bilateral lung volume loss (a). Axial chest CT image evidencing important upper lobe volume loss, apical cavitary lesions and multiple cylindric bronchiectasis (b and c).
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Chest x-ray (Figure 1A) showed hypotransparency of the upper thirds of both pulmonary hemifields with retractile findings and lung volume loss as well as a cavity in the right upper lobe (RUL). Chest CT confirmed RUL consolidation with cavitation; left upper lobe (LUL) peripheral consolidation with air bronchogram; important upper lobe (UL) volume loss and multiple cylindric bronchiectasis (Figure 1 B and C).
Chest CT and x-ray, 16 months after first Pulmonary Department admission. Significant wider cavitation in the right upper lobe and bilateral reticular infiltrates at the right lower lobe and left upper lobe (LUL) (a). Mass-like lesion (aspergilloma) inside LUL cavitation (b). Diffuse multifocal ground-glass opacities, sub-pleural micronodules, and tree-in-bud (c). Air fluid level at the RUL cavity on X-ray (d).
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He had worsened chest x-ray findings with a significant wider cavitation in the RUL and bilateral reticular infiltrates at the right lower lobe and LUL (Figure 2A). Revaluation by chest CT revealed size increase of RUL cavitation, condensation with air bronchogram particularly at the ULs, mass-like lesion inside LUL cavitation, diffuse multifocal ground-glass opacities, sub-pleural micronodules, and tree-in-bud (Figure 2 B and C). During hospitalization, he presented fast worsening of respiratory failure and severe acute hemoptysis with a sudden 3 g/dL drop of Hb and the evidence of a new chest x-ray finding of an air-fluid level at the RUL cavity (Figure 2D).