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Weekly Chest CasesArchive of Old Cases

Case No : 1090 Date 2018-09-18

  • Courtesy of Ye Kyeong Jun, Jeong Min Ko, Hyun Jin Park / Department of Radiology, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea
  • Age/Sex 57 / M
  • Chief ComplaintUnderlying disease (-), cough, sputum, sore throat, dyspnea
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Pseudomembranous tracheobronchitis, complicated by co-infection of Influenza A (H1N1) and Staphylococcus aureus
Radiologic Findings
Fig 1. Chest PA shows diffuse peribronchial cuffing and multifocal patchy GGO and consolidation in both lung fields. Heart is slightly enlarged.
Figs 2- 4. Lung window setting of the chest CT scan shows extensive tracheobronchial wall thickening with internal pseudomembrane, peripheral bronchiolitis, and focal consolidations in both lungs.
Brief Review
Pseudomembranous tracheobronchitis can cause central airway obstruction, although radiologic finding doesn’t show severe pneumonic infiltration. Etiologies of pseudomembranous tracheobronchitis could be divided into infectious and non-infectious origin; infectious causes include Corynebacterium , Aspergillus, Streptococcus, Bacillus cereus, Staphylococcus, and respiratory virus.
Although most of pseudomembranous tracheobronchitis usually develops in immunocompromised patients, such as organ transplant recipients or those with hematologic malignancies or long-term endotracheal intubation, co-infection with influenza could lead to pseudomembranous tracheobronchitis even in immunocompetent patients and prove tobe fatal.
Plain radiographs are relatively insensitive in detecting pseudomembranous tracheobronchitis. In some patients, peribronchial cuffing or findings of combined bronchopneumonia may be seen on plain radiographs. CT scans may show infiltrated and thickened tracheobronchial wall, narrowed lumen,loose new growth appearing in the airways, obstructive pneumonia, atelectasis, orpleural effusion.
Diagnosis is confirmed by pseudomembrane (fibrin, leukocytes, bacteria overlying a damaged mucous membrane) on bronchoscopy.
References
1) Tuberc Respir Dis 2015;78:366-370
2) Chinese Medical Journal 2012;125(7):1236-1241
Keywords
Lung, Airway, Viral infection, Bacterial infection,

No. of Applicants : 68

▶ Correct Answer : 1/68,  1.5%
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
▶ Semi-Correct Answer : 27/68,  39.7%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - National cancer center hospital east , Japan SHIOTO ODA
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Prince Sattam ibn Abdulaziz University hospital , Saudi Arabia ELBAGIR MOHAMED NASSIR
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Florence , Italy MARIAELENA OCCHIPINTI
  • - Kyoto Prefectural University of Medicine , Japan YOSHIAKI OTA
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - TB centre kasaragod. , India rikhy krishnan
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - Jiangsu province hospital , China WANGJIAN ZHA
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