CTICasesMycobacterium Avium Complex — Three Presentations
Imaging findings
Case 1: Middle-aged man with cavitary lesion and surrounding ground-glass opacity in the left upper lobe with tree-in-bud nodules in the left lower lobe, mimicking post-primary tuberculosis, in a patient without immunocompromise or the typical Lady Windermere phenotype. Case 2: Middle-aged former smoker with a mass-like opacity in the right middle lobe with distal obstructive changes suggesting endobronchial lesion; needle biopsy showed necrotizing granulomas and bronchoscopy recovered MAC. Case 3: 86-year-old woman with structural lung disease, diffuse middle lobe and lingula bronchiectasis, airway-centered nodules, multiple small cavities, and chronic bilateral airway involvement representing severe longstanding MAC.
Key takeaways
MAC can present with three very different CT patterns: the fibrocavitary form mimicking post-primary tuberculosis with upper lobe cavities and satellite nodules; a nodular or solitary mass form that can mimic lung cancer; and the classic Lady Windermere bronchiectatic form with middle lobe and lingula predominant cylindrical bronchiectasis and tree-in-bud nodularity. Recognizing all three forms is critical so that the appropriate diagnostic workup (BAL and culture) can be performed and unnecessary lung cancer workups avoided.
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