Case of the Month

November 1, 2008 Diagnostic Imaging. Case of the Month CLINICAL HISTORY A 38-year-old man with a history of asthma and sinus disease was referred to our pulmonary clinic for chronic productive cough with clear sputum. He denied hemoptysis, fevers, chills, wheezing, and dyspnea. He initially presented with an asthma exacer-bation that required antibiotics and a course of prednisone. CT chest acquired in 2001 demonstrated central bronchiectasis of unknown etiology. He had not returned to the clinic. IMAGING FINDINGS PA chest radiograph (Figure 1) demonstrates increased lung volumes with flattening of the diaphragm. Branching tubular opacities, tram-tracks, and ring shadows represent bronchiectasis with mucus plugging. The trachea and main bronchi are normal. Chest CT and minimum intensity projection images demonstrate central cylindrical/cystic bronchiectasis involving segmental/subsegmental bronchi, bronchial wall thickening with air/fluid levels, and mucus plugging (Figure 2A-D).

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