PMC5845528_01
(a, b) PA CXR showing biapical pleural thickening associated with parenchymal scarring, bronchiectasis, nodularity, and superimposed infiltrates.
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It revealed biapical pleural thickening associated with parenchymal scarring, bronchiectasis, nodularity, and superimposed infiltrates (Figure 1).
Solid white arrow outlining fluid-filled appendix suggestive of appendicitis.
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This revealed acute appendicitis in the right lower quadrant congruent with earlier physical examination findings (Figure 2).
Solid dense arrow delineating perirectal abscess in the saggital (a) and coronal (b) view of the abdominal CT scan.
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fig3
It also revealed a 3.1 x 1.9 cm dumbbell-shaped loculated fluid collection anterior to the anus consistent with perirectal abscess (Figure 3) confirming the etiology of his rectal discomfort.
(a) Diffuse airspace patchy consolidation with distention of bronchi and fluffy infiltrates. (b) Dense consolidation in the superior aspect of the right lower lobe with air bronchograms.
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Finally, CT gave more insight into suspected pulmonary TB as it revealed nodular and patchy consolidation in both lung bases along with dense consolidation, fluffy airspace infiltrates, distended, and distorted bronchi (Figure 4).
Granulomatous appendix (2x; 20 magnification).
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Foci of acute and granulomatous inflammation were appreciated (Figure 5) along with epithelioid histiocytes and multinucleated giant cells (Figure 6).
(a, b) H&E stain showing granulomatous inflammation of the appendix with solid black arrows depicting multinucleated giant cells. Central necrosis can be seen in image A outlined by solid white arrow (10x; 100).
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fig6
Foci of acute and granulomatous inflammation were appreciated (Figure 5) along with epithelioid histiocytes and multinucleated giant cells (Figure 6).
Solid black arrow depicting Ziehl-Neelsen AFB stain positive for acid-fast positive bacilli in the cytoplasm of a multinucleated giant cell (60x; 600).
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Initial acid-fast staining was negative, but a repeat stain revealed the presence of acid-fast bacilli in the cytoplasm of a multinucleated giant cell (Figure 7).