CTICasesIntrapulmonary Bronchogenic Cyst (with Hemorrhage/Infection)
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Imaging findings
A subtle nodular opacity in a 23-year-old male, better seen on lateral view. CT shows a nodular focus with surrounding ground-glass opacity, a broad airway full of mucus/debris, and a necrotic focus. A cystic portion, measuring zero Hounsfield units and of uniform fluid attenuation, was present and unchanged from a prior study two years ago. A hyper-enhancing focus, likely a reactive lymph node, is also present.
Key takeaways
This case presented with hemoptysis and a pre-existing intrapulmonary cystic lesion, which raised suspicion for a super-infected or hemorrhagic bronchogenic cyst, or potentially a parasitic infection, especially given the patient's origin. The presence of the unchanged cystic component over two years and the patient's age made cancer less likely. The recommended management was bronchoalveolar lavage (BAL) to look for organisms, followed by treatment and follow-up, possibly leading to wedge resection for definitive diagnosis if needed.
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