CTICasesUnexplained Symmetric Peribronchial Cystic Lung Disease in a Young West African Woman
Imaging findings
CT in a woman in her late 20s to early 30s adopted from West Africa at age 7 demonstrates striking bilateral symmetric peribronchial cysts or holes that are mid and upper zone predominant, with branching normal-looking bronchi passing through the cystic areas without volume loss. The fissures have small nodules along them in a perilymphatic distribution. Large bronchial arteries are identified. The outside institution called this cystic fibrosis, which is unlikely given her ethnicity and the absence of bronchiectasis or obstruction. Differential discussed includes sarcoidosis with cystic change, post-H1N1 ARDS sequelae, atypical mycobacterial infection, and LCH.
Key takeaways
Unexplained bilateral symmetric peribronchial cystic lung disease in a young West African woman remains diagnostically challenging. The absence of volume loss, normal-caliber airways passing through the cysts, perilymphatic nodules along fissures, and large bronchial arteries are important findings. While sarcoidosis is the leading clinical differential given demographics and distribution, the purely cystic pattern without honeycombing, bronchiectasis, or volume loss is atypical for advanced sarcoid. Post-H1N1 ARDS sequelae is another consideration given the documented H1N1 history and possible prior ICU illness. When the case fails to fit neatly into any established entity, thorough consideration of history and correlation with BAL and biopsy is warranted.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Fibrosing Mediastinitis from Histoplasmosis with Cor PulmonaleInfection
- Port-A-Cath Lead Fracture and Intracardiac MigrationIatrogenic
- Cryptococcus gattii Presenting as Solitary Lung Nodule with LeptomeningitisInfection
- Twiddler Syndrome — ICD Lead Coiling and Proximal MigrationIatrogenic
- Large Cystic Mediastinal TeratomaNeoplastic
- Cystic Lung Disease Mimicking UIP — Possible Airspace Enlargement with Fibrosis (AEF)ILD
- Unusual Bilateral Pleural Calcifications in a Young Man — Milk of CalciumOther
- Nocardia Pulmonary Infection in Stem Cell Transplant PatientInfection
See all cases from September 1, 2017 →