Persistent Lobar Atelectasis in a Patient With Chronic Hoarseness

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Persistent Lobar Atelectasis in a Patient With Chronic Hoarseness Chris L. Scelsi, DO, Tanya Khasnavis, BS, Nikhil G. Patel, MD, Jayanth H. Keshavamurthy, MD, William B. Davis, MD CHEST Volume 151, Issue 5, Pages e107-e113 (May 2017) DOI: 10.1016/j.chest.2017.01.029 Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 1 A, Posteroanterior and lateral radiographs of the chest (8 weeks after initial presentation) demonstrate atelectasis of the middle lobe. B, Coronal view contrast-enhanced CT scan demonstrates complete collapse of the middle lobe. CHEST 2017 151, e107-e113DOI: (10.1016/j.chest.2017.01.029) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 2 Axial views of contrast-enhanced CT image. A, Lung window demonstrating narrowing of the middle lobe bronchus (black arrow) distal to its origin from the bronchus intermedius (red asterisk). Atelectasis of the middle lobe is also seen here (yellow arrow). B, Intermediate lung-mediastinal window demonstrating nodular irregularity and thickening of the bronchus intermedius and the left main bronchus. Note the focal nodule representing an amyloidoma (yellow arrow) involving the posterior wall of the bronchus intermedius. Wall thickening and calcification of the left main bronchus is also demonstrated (black arrow). C, Mediastinal window demonstrating focal thickening (yellow arrow) of the anterior tracheal wall that causes luminal narrowing. CHEST 2017 151, e107-e113DOI: (10.1016/j.chest.2017.01.029) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 3 A, Three-dimensional volume reconstruction of the airway from the CT scan in Figure 2, demonstrating the irregular contour of the trachea. The collapsed middle lobe bronchus is absent (black arrow). B, CT-generated virtual bronchoscopy within the trachea near the level of the carina (asterisk) shows endobronchial nodularity with posterior tracheal membrane involvement. CHEST 2017 151, e107-e113DOI: (10.1016/j.chest.2017.01.029) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 4 H&E staining at (A) ×20 and (B) ×40 magnification of the biopsied bronchial wall demonstrating waxy eosinophilic extracellular deposits. A “cracked” appearance, better seen on B, is due to tissue processing. C, Congo-red staining at ×20 magnification demonstrating apple-green birefringence under polarized light. CHEST 2017 151, e107-e113DOI: (10.1016/j.chest.2017.01.029) Copyright © 2017 American College of Chest Physicians Terms and Conditions