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Obstructive Lung Diseases: Fellow Case Report Poster - Pulmonary Vascular Disease |

Unexpected Bronchoscopic Finding in a Patient With Right Middle Lobe Collapse

Abdulmonam Ali, MD; Brandon Stokey, MD; Mohammad Taleb, MD; Amal Milad, MD; Shehnaz Rahman, MD; Young Sook Yoon, MD
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University of Toledo, Toledo, OH


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4_S):910A. doi:10.1016/j.chest.2016.08.1010
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SESSION TITLE: Fellow Case Report Poster - Pulmonary Vascular Disease

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Middle lobe consolidation has multiple aetiologies, either obstructive or non-obstructive. Here we present a unique case of this condition.

CASE PRESENTATION: A 62-year-old male with a 40 pack-year history of smoking presented with cough and shortness of breathing. He reported persistent dry cough and feeling short of breath for about 6 months. He was using inhalers from his family members, however, his symptoms became worse five days prior to presentation, the cough became productive with yellow sputum. On exam, he was in acute respiratory distress. Chest auscultation revealed decreased breath sounds with diffuse expiratory rhonchi bilaterally. His initial ABG showed acute respiratory acidosis and he was placed on NIPPV. A Portable Chest X-ray showed hyperinflation, no evidence of pneumothorax or infiltrates. Computerized tomography (CT) angiography chest (Figure1) showed Centrilobular emphysema and no evidence of pulmonary embolism. However, there was collapse of the right middle lobe with no distinct mass. Patient was started on empiric levaquin, steroids and aerosols. A diagnostic bronchoscopy (Figure 2) showed rupture of cartilage at the subcarinal level of the right middle lobe lateral bronchus with no evidence of endobronchial lesion. BAL was positive for Haemophillus influenza. No acid fast bacilli. No fungal or mycobacterial growth. Cytology of transbronchial biopsy was negative for any malignant cells. During the hospital course, patient also had a chest percussion therapy. He reported improvement in his symptoms and discharged in stable condition.

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