대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 956 Date 2016-02-23

  • Courtesy of Choi Ye Ra, Cho Hyoun / SMG-SNU Boramae Medical Center
  • Age/Sex 77 / M
  • Chief Complaintno respiratory symptom, staging work-up for colon cancer
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Diagnosis With Brief Discussion

Diagnosis
Endobronchial actinomycosis associated with foreign body
Radiologic Findings
Chest PA shows subtle nodular opacities in the right lower lobar zone.
Chest CT images show radioopaque linear branching opacity in the right lower lobar and basal segmental bronchi. Associated mucus pluggings with peribronchial GGO and nodules were seen in the right lower lobe. On bronchoscopic exam, there was foreign body with granulation tissue at the entrance of right lower lobar basal bronchus. Bronchoscopic biopsy revealed actinomycosis with chronic active bronchitis.
Brief Review
Endobronchial actinomycosis can be associated with aspirated foreign material, such as a chicken bone, a tooth, a fish bone, a grape seed, or a bean. The bronchial infection results from direct aspiration of foreign body contaminated with Actinomyces organisms. CT may show a radioopaque endobronchial nodule, in cases of an aspirated bone fragment, with distal obstructive pneumonia. Rarely, both the parenchymal form and the endobronchial form can be encountered in one patient.
References
Tae Sung Kim, Joungho Han, Won-Jung Koh, et al. Thoracic Actinomycosis: CT Features with Histopathologic Correlation. American Journal of Roentgenology. 2006;186: 225-231
Keywords
Airway, Infection, Bacterial infection,

No. of Applicants : 83

▶ Correct Answer : 7/83,  8.4%
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Seoul national university , Korea (South) Kumju Chae
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
▶ Correct Answer as Differential Diagnosis : 9/83,  10.8%
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - Eren Hastanesi Istanbul , Turkey Armagan Sarac
  • - Policlinico Umberto I , Italy Paolo Baldassari
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - Medicheck health care , Korea (South) Chae Lim
  • - University of Tsukuba, Dept of Radiologt , Japan Manabu Minami
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - University of Tsukuba Hospital , Japan Sodai Hoshiai
▶ Semi-Correct Answer : 18/83,  21.7%
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - chonnam national university hospital , Korea (South) Kim eun
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Goa Medical College , India Paresh Desai
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - CHRU Lille , France Paul Lebert
  • - GHICL , France manuel toledano
  • - Shinmatsudo Central General Hospital , Japan Taku Tajima
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Seoul National University Hospital , Korea (South) Sunkyung Jeon
  • - Private sector , Greece Vasilios Tzilas
  • - SNUH , Korea (South) Juil Park
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
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