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Weekly Chest CasesArchive of Old Cases

Case No : 536 Date 2008-02-04

  • Courtesy of Eun-Ah Park, MD. / Seoul National Unoversity Hospital, Korea.
  • Age/Sex 70 / F
  • Chief ComplaintDyspnea
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Endobronchial Actinomycosis
Radiologic Findings
Figure 1. Chest PA shows nodular infiltrations in the left lower lobe.
Figures 2-4. Contrast-enhanced CT scans with mediastinal window setting revealed a calcified nodular dense lesion within the left lower lobe posterobasal segemtal bronchus.
Distal bronchi were filled with mucus plugs.
Figure 5. Chest CT scan with lung window setting shows multiple centrilobular nodules associated with bronchial obstruction.
Bronchoscopy showed a yellowish white hard mass occluding the bronchial lumen at the LLL posteroobasal segmental bronchus. The mass was removed with bronchoscopic forceps.
Histological examination of biopsied material was compatible with actinomycosis.
Brief Review
Primary endobronchial actinomycosis is rare, and only several cases have been reported in the literature. In some reports, endobronchial actinomycosis has been associated with foreign body aspiration. The formation of broncholiths may result from de novo calcification secondary to chronic inflammation associated with actinomycotic infection, and may be associated with aspirated materials.
The most common granulomatous infections associated with broncholithiasis include H. capsulatum and M. tuberculosis. The mediastinal lymph node involved in the granulomatous process becomes calcified into indivicual masses, and ultimately erode in the airway. The other differential diagnosis for the endobronchial calcified mass includes foreign bodies and calcified endobronchial neoplasm. Although it is very rare, endobronchial actinomycosis should be included in the differential dignosis of calcified endobronchial masses, especially when there is no clinical or radiological evidence of a granulomatous infection, such as tuberculosis, and the yellowish materials obstructing the bronchus are seen during bronchoscopy.
References
1. Seo JB, Lee JW, Ha SY, Park JW, Jeong SH, Park GY. Primary endobronchial actinomycosis associated with broncholithiasis. Respiration 2003;70:110-113
Keywords
Airway, Lung, Infection, Bacterial infection,

No. of Applicants : 61

▶ Correct Answer : 2/61,  3.3%
  • - Armed Forces ChunCheon Hospital (AFCC), Korea Chae Hun Lim
  • - CHU de Poitiers, France Paul Ardilouze
▶ Correct Answer as Differential Diagnosis : 7/61,  11.5%
  • - Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
  • - Gimpo Woori Hospital, Korea Son Youl Lee
  • - China Medical University, Taiwan Jun-Jun Yeh
  • - Dongguk University International Hospital, Korea Hee Seok Choi
  • - IRSA La Rochelle, France Jean-Luc Bigot
  • - Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
  • - Jackson Memorial Hospital, Miami, Florida, USA N.B.S. Mani
▶ Semi-Correct Answer : 35/61,  57.4%
  • - Shiga University of Medical, Japan Norihisa Nitta
  • - Tri-Service General Hospital, Taiwan Tsun-Hou, Chang
  • - Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Osaka University, Japan Osamu Honda
  • - Asan Medical Center, Korea Dae Yoon Kim
  • - Hopital Nord - CHU St Etienne, France Romain Malezieux
  • - Regional Imaging Riverina, Australia Rashid Hashmi
  • - Az. Osped. Santa Maria - Terni, Italy Angelo Carloni
  • - Lilavati Hospital & Rsearch Centre, Mumbai, India Mahavir Swami
  • - Saga University, Japan Ryoko Egashira
  • - Vital imaging centre, Mumbai, India Ganesh Agrawal
  • - Shinsegye Rad Clinic, Daegu, Korea Gi Beom Kim
  • - Ondokuz Mayis University, Samsun Turkey Cetin Celenk
  • - Sushrusha Hospital, Mumbai, India Ajay Kumar
  • - Dong-A University Hospital, Busan, Korea Ki Nam Lee
  • - Unifesp, Sao Paulo, Brazil Gustavo Meirelles
  • - Clinic 1, Moscow, Russia Lepikhina Dasha
  • - Annecy, France Antoine Marie
  • - Soonchunhyang university Bucheon hospital, Korea Min Hee Lee
  • - Hospital Sotiria, Athens, Greece Vasilios Tzilas
  • - Vitalife Clinics, Pune, India Rahul Deshmukh
  • - Annecy Hospital, France Gilles Genin
  • - Mokpo Hankook Hospital, Korea Sang Uk Park
  • - Medinova Diagnostics, Bheemavaram, AP, India Harsha Vardhan
  • - Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
  • - IRSA, La Rochelle, France Denis Chabassiere
  • - Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
  • - Ultra Care Coimbatore, India Debabrata Das
  • - Nassau, Bahamas Trupti Dabholkar
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - Aims, New Delhi, India Ashish Gupta
  • - Armidale Radiology, Australia Saurabh Khandelwal
  • - Pittwater Radiology, Australia Julie Arora
  • - catholic university of korea , Korea (South) hanna kim
  • - Catholic medical center , Korea (South) Hyejung Park
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