PMC7425252_01
(A and B) Anteroposterior and lateral chest X-ray. Central trachea and cystic images with thin walls less than 4 cm in the lower two thirds of both lungs, some with presence of air fluid level (black arrow).
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Chest X-ray showed a central trachea and multiple thin-walled cystic images, occupying the lower two thirds of both hemithorax, no masses, or pneumothorax (Figure 1).
(A, B, C, and D) Thoracic computed tomography scan, coronal and sagittal planes. Dilated trachea of 28 x 33 mm (anteroposterior x transversal) and enlarged mainstem bronchi with a diameter of the right mainstem bronchus and left mainstem bronchus of 22 mm and 17 mm (pointed lines), respectively. Several peripheric thin-walled cysts are observed, which correspond to cystic bronchiectasis (thick black arrow), with partial sparing of pulmonary apices. (E and F) Coronal maximum intensity projection reconstruction. Scalloping of tracheal wall with presence of diverticula (thin white arrow) and peripheric cystic bronchiectasis with air fluid levels and apical sparing.
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Thoracic CT scan showed an increased tracheal diameter, measuring 28 x 33 mm (anteroposterior x transversal) 2 cm above the aortic arch, with atonic walls and presence of cylindrical and cystic bronchiectasis (Figure 2A). Enlarged mainstem bronchus with a right mainstem bronchus (RMB) and left mainstem bronchus (LMB) diameter of 22 and 17 mm, respectively (Figure 2B-F).
(A) Three-dimensional coronal volumetric reconstruction of the airway. A gradual dilatation of the trachea is observed (narrow white arrow), along diffuse enlargement of bronchi, predominantly showing basal predominance with presence of bronchiectasis (thick white arrow). (B) Coronal multiplanar reconstruction with digital subtraction. Compromise of intraparenchymal airway by cylindrical and cystic bronchiectasis that appear "blueish" giving a cobblestone appearance (black arrow), with surrounding normal "white" parenchyma. Black spaces correspond to subtractions of the remaining thoracic structures.
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On 3-dimensional coronal volumetric reconstruction and multiplanar reconstruction with digital subtraction, a gradual enlargement of the trachea and diffuse dilatation of the bronchi is observed, along with cystic bronchiectasis that give a cobblestone appearance (Figure 3).
Bronchoscopy. (A) Dilated trachea with mucosal edema and diverticula causing the mucosa to protrude between cartilaginous rings. (B and C) Edematous mainstem bronchus with presence of purulent material.
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Similarly, on the left main bronchus, a loss of normal structure is seen, with multiple purulent filled cavitations (Figure 4).
(A and B). Anteroposterior and lateral chest X-ray. Tracheal dilatation (white arrows) associated to thin-walled cystic images (black arrows) in the lower two thirds of both lungs, presence of several air fluid level, with improvement compared with initial chest X-ray.
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A control chest X-ray showed an improvement in pulmonary radiolucency with decrease in air fluid levels (Figure 5).