Presentation
Previous history of a floor of mouth SCC treated with partial mandibulectomy and segmental mandibular fibula free flap. Presenting with cough.
Patient Data
Diffuse and prominent bronchial wall thickening and tree-in-bud centrilobular nodules within both lungs lower lobes, which are reduced in volume due to partial collapse. Some of the bronchi are fully obliterated by mucous material. The bronchial tree is unremarkable in the remainder of the lobes. Diffuse centrilobular emphysematous changes again noted within the upper lobes. No suspicious mediastinal lymph nodes.
Case Discussion
The CT chest demonstrates diffuse basilar bronchiectasis with bronchial wall thickening and mucus plugging, as weel as centrilobular nodules and tree-in-bud pattern. Given the distribution within the lower lobes (gravity dependent) and the history of an extensive head and neck surgery and radiotherapy, these findings are likely to represent changes due to subacute/chronic aspiration. Note that ground-glass and consolidation are not present.
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