PMC8709545_01
(A) Radiograph of the right upper lobe nodal consolidation with internal cyst formation. (B) Radiograph of right upper lobe cavitary mass like opacity with left lower lobe nodule. (C) Chest radiograph, multiple bilateral cavitary lesions with air-fluid levels, and the largest in the right upper lobe.
IMCRJ-14-829-g0001.jpg
PMC8709545_01_IMCRJ-14-829-g0001.jpg
f0001
His chest X-ray showed an isolated pulmonary nodule in the right upper lobe, so he was referred to the pulmonary clinic (Figure 1A). A repeat chest x-ray showed progression of dimensions of multiple cavities with air-fluid levels (Figure 1C).
(A) CT thorax mediastinal window: right upper lobe mass like with central cavitation, 7.3x7 cm in size. (B) CT thorax pulmonary window, multiple bilateral nodules show dominance of lower lobe with bilateral mild bronchial wall thickening. (C) CT thorax mediastinal window: CT-guided needle biopsy from the right upper lobe mass with central cavitation. (D) CT thorax pulmonary window. Cavitation of the right upper lobe. (E) CT thorax pulmonary window, October 1/2021: Right upper lobe cavitary lesion measuring 3.8x2.4 cm, previously 3.8x3 x 2.8 cm with solid internal component and Crescent air sign, raising the possibility of underlying fungal ball. (F) CT thorax pulmonary window, October 1/2021: showed bilateral cavitary lung lesions, one right lower lobe, one lingua and 2 left lower lobe.
IMCRJ-14-829-g0002.jpg
PMC8709545_01_IMCRJ-14-829-g0002.jpg
f0002
An imaging examination on February 10, 2020 revealed multiple nodules of varying sizes on both sides of the chest and an enlarged lung mass in the right upper lobe with multiple mediastinal lymph nodes (Figure 2A and B). He was admitted to our hospital on February 15, 2020, and a CT -guided lung biopsy was performed under local anesthesia without complications from the cavitary lesion of the right upper lobe (Figure 2C and D).
(A and B) Histopathological findings of lung biopsy of right upper lobe, medium-sized vessels (arteries and veins) are rarely seen and are probably destroyed by the inflammation and replaced by scattered relatively small necrosis consisting of degenerating karyorrhectic neutrophils with basophilia and eosinophils with fibrinoid necrosis (probable foci of leukocytoclastic vasculitis). 8, there are small epithelioid granulomatous collections with occasional central small necrosis, and few multinucleated giant Langerhans-type cells are noted.
IMCRJ-14-829-g0003.jpg
PMC8709545_01_IMCRJ-14-829-g0003.jpg
f0003
Eosinophilic granulomatosis with polyangiitis was ruled out in this case based on the clinical history (no asthma, no atopy, and no significant peripheral eosinophilia) (Figure 3A and B).