Presentation
Multiple episodes of RUL pneumonia history of tobacco use, concern for post-obstructive pneumonia, please evaluate for possible lung mass"
Patient Data
Spot the abnormal lobe
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
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.