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Actinomycosis - pulmonary manifestations on chest radiographs

Case contributed by Jayanth Keshavamurthy
Diagnosis certain

Presentation

Multiple episodes of RUL pneumonia history of tobacco use, concern for post-obstructive pneumonia, please evaluate for possible lung mass"

Patient Data

Age: 55 years
Gender: Male

Spot the abnormal lobe

x-ray

Frontal and lateral views of the chest demonstrate chronic interstitial lung markings, which are actually more prominent in the right upper lobe and right lower lobe suggestive of scarring. This is stable for 10 years. There is interposition of colon between liver and right hemidiaphragm.

8 yr later the CXR shows

x-ray

Right upper lobe findings are similar. Grossly no change.

Final Pathologic Diagnosis on Bronchoscopy in 2007

LUNG, POSTERIOR SEGMENT OF RIGHT UPPER LOBE (ENDOBRONCHIAL BIOPSY):

  • benign bronchial mucosa demonstrating moderate to severe acute    
  • and chronic inflammation, squamous metaplasia 
  • micro-organisms consistent with actinomycetes group

GMS:  Positively staining filamentous branching bacilli

Gram:  Positively staining filamentous branching bacilli

No evidence of malignancy seen.

Case Discussion

The chest X-ray findings are stable for 8 years. It is a microbiology finding.

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