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Images in Thorax
Not all wheeze is asthma
  1. Kher Lik Ng1,
  2. John Park1,
  3. Elizabeth Belcher2,
  4. Alastair J Moore1
  1. 1 Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to Dr Kher Lik Ng, Oxford Center for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK; kherlik.ng{at}ouh.nhs.uk

https://doi.org/10.1136/thorax-2023-220953

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    A 41-year-old man previously diagnosed with asthma presented with an influenza-like illness and breathlessness. He was treated for moderate-to-severe COVID-19 and exacerbation of asthma. CT pulmonary angiography (CTPA) revealed asymmetrical peribronchovascular ground-glass infiltrates consistent with COVID-19 and right main bronchial wall thickening with high-density material thought to be consistent with mucous impaction (figure 1A). He was discharged 8 days after admission.

    Figure 1

    (A) Coronal view of CT pulmonary angiography (CTPA) performed on the first acute presentation of COVID-19 infection showing the appearance of high-density material with septations thought to be consistent with the appearance of mucous impaction associated with bronchial wall thickening in the right main bronchus (RMB). (B,C) Coronal and axial views of CTPA performed on second acute presentation with haemoptysis showing the high-density material and progression of bronchial wall thickening in the RMB. (D) Coronal view of low-dose CT chest performed 6 months after rigid bronchoscopy and foreign body extraction showing resolution of changes.

    At review 4 months later, he reported ongoing breathlessness and cough productive of green sputum. …

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    Footnotes

    • Twitter @jp_jespark

    • Contributors KLN wrote the case report and dealt with the submission of the manuscript. JP, EB and AJM reviewed and amended the case report appropriately. JP, EB and AJM also provided feedback to improve the abstract and title. AJM and EB were the lead clinicians for the patient.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.