1. MedPix Medical Image Database COW - Case of the Week Case Contributor: James M Grimson Affiliation: Naval Medical Center Portsmouth

2. MedPix No: 9354 - History Pt Demographics: Age = 17 y.o. Gender = girl 17 year old girl with previously diagnosed illness presents for followup to document progression of disease. Downloaded by (-1)

3. MedPix No: 9354 - EXAM & LABS Not provided

4. Cystic Fibrosis Frontal chest radiograph taken near the date of the CT exam demonstrates some central mucous plugging, especially on the left. Bronchiectasis is suggested in the upper fields, with subtle *tram-tracks* seen. A central line *mediport* is in good positionon the right anterior chest wall, with the catheter tip in the superior vena cava (SVC). Downloaded by (-1)

5. Cystic Fibrosis - closeup Frontal chest radiograph taken near the date of the CT exam demonstrates some central mucous plugging, especially on the left. Bronchiectasis is suggested in the upper fields, with subtle *tram-tracks* seen. A central line *mediport* is in good positionon the right anterior chest wall, with the catheter tip in the superior vena cava (SVC). Downloaded by (-1)

6. Cystic Fibrosis Frontal chest radiograph taken near the date of the CT exam demonstrates some central mucous plugging, especially on the left (arrowheads). Bronchiectasis is suggested in the upper fields, with subtle *tram-tracks* seen (arrows). A central line (between red lines) *mediport* is in good position on the right anterior chest wall, with the catheter tip in the superior vena cava (SVC). The proximal trachea and bronchi are outlined in darkblue. Light blue circles outline thickened bronchial walls on-end. Downloaded by (-1)

7. Cystic Fibrosis Lateral chest radiograph taken near the date of the CT exam demonstrates some central mucous plugging. Bronchiectasis is suggested in the upper fields, with subtle *tram-tracks* seen. A central line *mediport* is in good position on the anterior chest wall. Downloaded by (-1)

8. Cystic Fibrosis There are multiple dilated bronchi (bronchiectasis) with bronchial wall thickening in both upper lobes, consistent with chronic bronchitis. Downloaded by (-1)

9. Cystic Fibrosis Bronchiectasis is seen in both upper lobes, with prominent mucous plugging on the left. The dilated bronchi also have thick walls. Downloaded by (-1)

10. Cystic Fibrosis Bronchiectasis is seen in both upper lobes, with prominent mucous plugging on the left side (yellow arrowheads). The dilated bronchi also have thick walls - seen best on the right side (red arrows). Also labeled: T - trachea Downloaded by (-1)

11. Cystic Fibrosis Less severe bronchiectasis is seen in both lower lobes, with some peripheral mucous plugging noted bilaterally. The dilated bronchi also have thick walls. Downloaded by (-1)

12. Cystic Fibrosis Less severe bronchiectasis is seen in both lower lobes, with some peripheral mucous plugging noted bilaterally. The dilated bronchi also have thick walls. Labeled: - A - descending thoracic aorta - Az - Azygous vein - E - esophagus (with a tiny bit of air) - IVC - inferior vena cava - LV - left ventricle - RV - right ventricle - V - vertebral body Downloaded by (-1)

13. FINDINGS There is marked bronchiectasis bilaterally, involving all lobes but most prominent in the upper lobes. Prominent mucous plugging is also noted, predominantly in the left upper lobe.

14. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? Cystic Fibrosis - Allergic bronchopulmonary aspergillosis - Tuberculosis (TB) -

15. Diagnosis: Cystic Fibrosis Dx Confirmed by: Sweat test & classic imaging

16. DISCUSSION See companion cases: http://rad.usuhs.edu/medpix/medpix.html?mode=image_finder&action=search&srchstr=cys tic%20fibrosis&srch_type=all