Presentation
Frequent coughing episodes for 2.5 years. Inflammatory airway disease diagnosed 2.5 years ago.
Patient Data
There are multifocal areas of mineralization throughout the lung lobes. These mineral foci are centered on airways. There is also a moderate, diffuse bronchial pattern present. On the left lateral projection, there is an alveolar pattern and lobar sign associated with the right middle lung lobe, with volume loss. The cardiac silhouette is mildly enlarged, and the vasculature is normal.
The bronchial pattern is consistent with chronic lower airway disease. Mineral opacities likely represent broncholiths. Atelectasis of the right middle lung lobe secondary to chronic airway obstruction.
Mild cardiomegaly may indicate cardiomyopathy.
Case Discussion
Chronic inflammatory disease causes bronchial plugging with mucus and debris. This material can mineralize within the airways, causing broncholiths. The mineral opacity of theses structures indicates a benign process, and the airway association indicates inflammatory disease. When these broncholiths obstruct a major bronchus, atelectasis can result. The right middle lung lobe, being the smallest surface area, is most commonly affected with atelectasis secondary to airway obstruction.
The imaging characteristics provide the main evidence for diagnosis, along with the history of asthma.
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