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A 44-year-old woman with longstanding asthma was referred for worsening cough over a 2-year period. She reported frequent exacerbations, with purulent sputum and occasional small volume haemoptysis. Smoking history was minimal (1.5 pack years). She had a prolonged history of sinus infections and documented prior pneumonia, pertussis infection, but no known TB exposure.Sputum grew Haemophilus influenzae but was negative for atypical organisms including mycobacteria. Radiology showed severe cystic bronchiectasis within the left lower lobe (Figure 1). PET CT imaging showed the lesion to be non-FDG avid, with no significant lymphadenopathy. Bronchoscopy revealed an obstructing polypoid lesion at the orifice of the left lower lobe (Figure 2). Multiple biopsies and brushings demonstrated only normal bronchial mucosa.Following discussion at the lung cancer multidisciplinary meeting the patient underwent left lower lobe lobectomy.What is the diagnosis?Answer and Discussion Learning points This case highlights the importance of bronchoscopic evaluation in the presence of lobar collapse, especially in a young patient. There is a definite role for surgery in bronchiectasis when associated with endobronchial neoplasms, or when disease is severe and localised to a single lobe.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Thomas C Reid, Medical Registrar, Department of Medicine, Taranaki Base Hospital, New Plymouth; Vinu Abraham, Consultant Physician (Internal medicine/Pulmonologist), Department of Medicine, Taranaki Base Hospital, New Plymouth.

Acknowledgements

Thanks to Mr Fancourt and Brigitte Watson for surgical photography, Ms Charmaine Tarrant for photographic editing, and Dr J Hunt for assistance with histology.

Correspondence

Correspondence Email

drtom.c.reid@gmail.com

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 44-year-old woman with longstanding asthma was referred for worsening cough over a 2-year period. She reported frequent exacerbations, with purulent sputum and occasional small volume haemoptysis. Smoking history was minimal (1.5 pack years). She had a prolonged history of sinus infections and documented prior pneumonia, pertussis infection, but no known TB exposure.Sputum grew Haemophilus influenzae but was negative for atypical organisms including mycobacteria. Radiology showed severe cystic bronchiectasis within the left lower lobe (Figure 1). PET CT imaging showed the lesion to be non-FDG avid, with no significant lymphadenopathy. Bronchoscopy revealed an obstructing polypoid lesion at the orifice of the left lower lobe (Figure 2). Multiple biopsies and brushings demonstrated only normal bronchial mucosa.Following discussion at the lung cancer multidisciplinary meeting the patient underwent left lower lobe lobectomy.What is the diagnosis?Answer and Discussion Learning points This case highlights the importance of bronchoscopic evaluation in the presence of lobar collapse, especially in a young patient. There is a definite role for surgery in bronchiectasis when associated with endobronchial neoplasms, or when disease is severe and localised to a single lobe.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Thomas C Reid, Medical Registrar, Department of Medicine, Taranaki Base Hospital, New Plymouth; Vinu Abraham, Consultant Physician (Internal medicine/Pulmonologist), Department of Medicine, Taranaki Base Hospital, New Plymouth.

Acknowledgements

Thanks to Mr Fancourt and Brigitte Watson for surgical photography, Ms Charmaine Tarrant for photographic editing, and Dr J Hunt for assistance with histology.

Correspondence

Correspondence Email

drtom.c.reid@gmail.com

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 44-year-old woman with longstanding asthma was referred for worsening cough over a 2-year period. She reported frequent exacerbations, with purulent sputum and occasional small volume haemoptysis. Smoking history was minimal (1.5 pack years). She had a prolonged history of sinus infections and documented prior pneumonia, pertussis infection, but no known TB exposure.Sputum grew Haemophilus influenzae but was negative for atypical organisms including mycobacteria. Radiology showed severe cystic bronchiectasis within the left lower lobe (Figure 1). PET CT imaging showed the lesion to be non-FDG avid, with no significant lymphadenopathy. Bronchoscopy revealed an obstructing polypoid lesion at the orifice of the left lower lobe (Figure 2). Multiple biopsies and brushings demonstrated only normal bronchial mucosa.Following discussion at the lung cancer multidisciplinary meeting the patient underwent left lower lobe lobectomy.What is the diagnosis?Answer and Discussion Learning points This case highlights the importance of bronchoscopic evaluation in the presence of lobar collapse, especially in a young patient. There is a definite role for surgery in bronchiectasis when associated with endobronchial neoplasms, or when disease is severe and localised to a single lobe.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Thomas C Reid, Medical Registrar, Department of Medicine, Taranaki Base Hospital, New Plymouth; Vinu Abraham, Consultant Physician (Internal medicine/Pulmonologist), Department of Medicine, Taranaki Base Hospital, New Plymouth.

Acknowledgements

Thanks to Mr Fancourt and Brigitte Watson for surgical photography, Ms Charmaine Tarrant for photographic editing, and Dr J Hunt for assistance with histology.

Correspondence

Correspondence Email

drtom.c.reid@gmail.com

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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