A rapidly growing lung mass with air crescent formation
- Harpreet K Lota1,
- Michael Dusmet2,
- Katrine Steele3,
- Athol U Wells1,
- Andrew G Nicholson4,
- David M Hansell5,
- Elisabetta A Renzoni1
- 1Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- 2Department of Thoracic Surgery, Royal Brompton Hospital, London, UK
- 3Department of Respiratory Medicine, Western Sussex Hospitals NHS Trust, Worthing, UK
- 4Department of Histopathology, Royal Brompton Hospital, London, UK
- 5Department of Radiology, Royal Brompton Hospital, London, UK
- Correspondence to Dr Harpreet K Lota, Interstitial Lung Disease Unit, Royal Brompton Hospital, London, SW3 6NP, h.lota{at}rbht.nhs.uk
- Allergic Alveolitis
- Interstitial Fibrosis
- Sarcoidosis
- Anca-Related Vasculitides
- Asbestos-Induced Lung Disease
- Bronchiectasis
- Drug-Induced Lung Disease
- Pulmonary Eosinophilia
- Pulmonary Vasculitis
Pulmonary puzzle
A 58-year-old man who never smoked and was under follow-up for polymyositis associated with fibrotic interstitial lung disease was found to have an incidental opacity in the right upper lobe on a chest radiograph. He had been treated with daily azathioprine 200 mg and prednisolone 10 mg for 15 years. A CT chest revealed a mass-like lesion of relatively low attenuation suggesting necrosis (figure 1). Bronchoalveolar lavage was negative for microbiology and cytology. CT-guided biopsies were reported as showing necrosis and inflammation only. A month later, he developed cough with malodorous sputum, generalised fatigue, mild fevers, sweats and dyspnoea.
Initial CT through the upper lobes showing an amorphous relatively low attenuation (near-fluid density) mass in the posterior segment of the right upper lobe. Sections through …
