IMAGES IN THORAX
Bronchial cast formation associated with loss of immunoglobulin and calcium
1 Vivantes Auguste Viktoria Klinikum, Klinik für Kardiologie und Diabetologie, Berlin, Germany
2 Hospital Dienstleistung and Beratung GmbH – Laborverbund, Bernau, Germany
3 Evangelische Lungenklinik Berlin, Berlin, Germany
Correspondence to:
Dr C Herzmann, Vivantes Auguste Viktoria Klinikum, Klinik für Kardiologie und Diabetologie, Berlin 10829, Germany; christian.herzmann@web.de
| The first 150 words of the full text of this article appear below. |
A 42-year-old Caucasian woman presented with dyspnoea and expectoration of white stringy phlegm with a consistency between goat’s cheese and chewing gum (fig 1). She had had recurrent respiratory infections since childhood. In 1997 she noticed exertional dyspnoea and in 1999 she started producing bronchial casts. Pulmonary fibrosis was diagnosed based on a high-resolution CT scan which showed ground-glass opacities consistent with active early fibrosis. Prednisolone was started following an open lung biopsy which revealed bronchiolitis with peribronchial inflammation-associated fibrosis. Subsequent scans showed reduced alveolitis but progressive fibrosis. In 2004, tuberculosis was diagnosed on sputum culture and treated. Cultures have remained negative since. Azathioprine was introduced in 2005 and high-dose acetylcysteine was added in 2006. The patient started coughing up 250 ml milky fluid daily when nebulisers with hypertonic saline were introduced in May 2006.
Figure 1 Expectorated bronchial cast.
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Her medication on admission included prednisolone, azathioprine, acetylcysteine and prophylactic
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Thorax 2008 63: 663.[Extract] [Full Text] [PDF]
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