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Chronic pulmonary suppuration
  1. S Banerjee,
  2. P Sundaram,
  3. J M Joshi
  1. Department of Respiratory Medicine, T N Medical College, B Y L Nair Hospital, Mumbai, 400 008 India
  1. Dr Joshi

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A 25 year old male non-smoker presented to us with a history of cough with mucopurulent expectoration and dyspnoea on exertion since childhood. There were symptoms of frequent

infective exacerbations requiring antibiotic treatment. Empirical antituberculosis treatment had been given two years before on the basis of symptoms and chest radiographicfindings in another institute. On physical examination, there was pallor but clubbing was absent. Chest examination revealed bronchial breath sounds in the right infrascapular area and bilateral coarse crackles. Haematological investigations showed anaemia with a haemoglobin concentration of 120 g/l, but other biochemical parameters were within normal limits. Sputum smear and culture examination were negative for bacteria and acid-fast bacilli. Spirometry showed a restrictive abnormality: forced vital capacity (FVC) 1.5 litres (predicted 4.05 litres), forced expiratory volume in one second (FEV1) 1.25 litres, and FEV1/FVC ratio of 83%; arterial blood gas analysis gave normal results. His chest radiograph (fig 1) and high resolution computed tomography (HRCT) are as shown in fig 2A and B.

Figure 1

Chest radiograph showing right lower lobe collapse.

Figure 2

(A) HRCT showing right lower lobe collapse with bronchiectasis and (B) HRCT at the level of the trachea showing tracheomegaly.

Questions

(1)
What are the findings on chest radiograph and HRCT?
(2)
What is the differential diagnosis and how is the diagnosis confirmed?
(3)
What is the treatment of this condition and what are the likely complications?

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