1. Right Middle Lobe Collapse and Pleural Effusion in an 18-Year-Old Man
Joshua Patterson, MD, David Graham, MD, Alan George, DO, Micah Will, MD, Deena Sutter, MD 
CHEST 
Volume 152, Issue 2, Pages e33-e38 (August 2017)
DOI: /j.chest
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2. Figure 1
Posteroanterior radiograph shows findings show dense opacification of the right lower hemithorax associated with shift of the heart to the right side, findings consistent with likely combination of effusion and underlying basilar atelectasis.
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3. Figure 2
Contrast-enhanced coronal CT image at the level of the carina shows combination of large right-sided effusions and diffuse opacification/atelectasis of the corresponding lower lung field lobe confirming shift of the heart to the right (Fig 1). There are right hilar calcifications, including bulky calcified nodes causing marked narrowing/obstruction of the bronchus intermedius (arrow). Ill-defined nodular densities are also noted in the right upper lobe/apex.
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4. Figure 3
There are subtle punctate calcifications in the spleen that is otherwise normal in size. There is no evidence of ascites.
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5. Figure 4
Caseo-fibrous lesions with microcalcifications. Organisms cannot be reliably distinguished from the microcalcifications; however, there are some features that suggest organisms over calcifications to include the distinct round/spherical shape as opposed to the coarse granules of calcifications, the lighter color, and the refractile appearance with a border suggestive of a capsule. (Hematoxylin and eosin stain, 40×.)
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6. Figure 5
Demonstration of 3- to 5-μm oval, thin-walled yeast present within an area of necrosis. (Grocott methenamine silver stain, 40×).
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