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Weekly Chest CasesCases by Disease Category

Case No : 1328 Date 2023-04-03

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  • Courtesy of Jinyoung Lee, Kyongmin Sarah Beck / Seoul St. Mary
  • Age/Sex 65 / F
  • Chief Complaintfever and cough for 1 week, recurrent pneumonia for 2 years
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Endobronchial actinomycosis and associated with broncholith and aspergillosis
Radiologic Findings
Fig 1. Chest PA shows ill-defined consolidation in the lateral aspect of right lower lung zone.
Fig 2-6. Chest CT with mediastinal window setting and lung setting shows ill-defined low-attenuation consolidation with inner calcification or broncholith in the anterior basal segment of RLL. Segmental bronchus is obstructed, resulting in tubular mucus bronchogram and obstructive pneumonia in the distal portion.

On bronchoscopic exam, there was a necrotic and brownish material obstructing the orifice of the anterior basal segmental bronchus of the right lower lobe. Bronchoscopic biopsy was done, and the histopathological examination revealed aggregated fungal hyphae and bacterial colonies, confirming the diagnosis of aspergillosis and actinomyces.
Brief Review
Endobronchial actinomycosis is a rare type of infection caused by the actinomyces. It results from colonization of preexisting obstructive broncholiths or endobronchial foreign bodies, which inflames the adjacent airway and causes distal obstructive pneumonia. Broncholiths are usually formed by erosion of calcified lymph nodes into the airway as a result of a granulomatous process. We speculate that a preexisting broncholith was secondarily infected by Actinomyces and Aspergillus, as one of the common co-pathogens for thoracic actinomycosis have been described as Aspergillus
On CT, endobronchial actinomycosis is seen as a proximal obstructive calcified endobronchial nodule with distal obstructive pneumonia of the involved lobe or segment. Distal post-obstructive pneumonic consolidation usually shows a central low-attenuation area with or without cavities.

References
Keywords

No. of Applicants : 100

▶ Correct Answer : 28/100,  28.0%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan KYOKO NAGAI
  • - , Italy PAOLO BALDASSARI
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Chonnam National University Hwasun Hospital , Korea (South) DONGHUN HAN
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan KENTARO KOTANI
  • - Peking University Third Hospital , China MING LU
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Other , Korea (South) SEONG WON JANG
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - , Korea (South) HM PARK
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Chonnam National University Hospital , Korea (South) JAEBONG YANG
▶ Correct Answer as Differential Diagnosis : 10/100,  10.0%
  • - Chonnam National University Hwasun Hospital , Korea (South) KWANGKUN CHO
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - , Korea (South) JIN YOUNG LEE
  • - Inje University Pusan Paik Hospital , Korea (South) GANGWON JEONG
  • - Presbyterian Medical Center , Korea (South) SOOYEON JEONG
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Seoul National University Hospital , Korea (South) SUNGHO HONG
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Kyoto University , Japan SHO KOYASU
▶ Semi-Correct Answer : 18/100,  18.0%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Ajou University Hospital , Korea (South) SUNG HYUN AN
  • - Chonnam National University Hwasun Hospital , Korea (South) SEONGWOO CHO
  • - , Japan FUMINORI MIYOSHI
  • - , United Arab Emirates GAYATHRI GANAPATHY
  • - Osaka University , Japan AKINORI HATA
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - Chungbuk National University Hospital , Korea (South) SOHUI JIN
  • - Presbyterian Medical Center , Korea (South) HANLIM SONG
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
  • - Others , India PURUSHOTHAMA RAO TUMMALA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Shiga University of Medical Science , Japan RYO UEMURA
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - , Korea (South) JIN WOO YOON
  • - Jiangsu province hospital , China WANGJIAN ZHA
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