Demographics:
27 years old, Female
Indication:
Chest pain, cough
Findings
Chest radiograph
- Cavitary lesion in the superior segment of the right lower lobe
- Bilateral breast implants
CT
Chest
- Clusters of tree-in-bud nodularity in the superior segment of the right lower lobe with associated bronchiectasis and two irregular, thick-walled cavitary lesions (#1, #2), the larger of which measures 3.5 x 2 cm in transaxial dimensions
- Calcified subcarinal and right hilar lymph nodes
Upper abdomen
- Apparent filling defect in the SMV extending to the portosplenic confluence
- Scattered tiny calcified granulomas in the liver and spleen
MSK
- Bilateral breast implants
- No acute osseous findings
Diagnosis
Cavitary mycobacterium avium intercellulare infection
Sample Report
Sequela of granulomatous disease. Tree-in-bud nodularity and larger cavitary nodules in the superior segment of the right lower lobe are concerning for an acute on chronic atypical infection, with differential considerations including tuberculosis and fungal infections (e.g. coccidioidomycosis). Consider bronchoscopy for further evaluation.
Apparent filling defect in the SMV extending to the portosplenic confluence. While this could represent mixing artifact, nonocclusive thrombus is a consideration. Consider obtaining an abdominal CT with contrast or abdominal ultrasound for further evaluation.
Discussion