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Age: 27

Sex: Female

Indication: Chest pain, cough

Save ("V")

Case #26


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, 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.


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