A 22 yo male presents with worsening chronic cough and breathlessness. He has been underweight since childhood.
click image to enlarge
Describe and interpret his CXR and CT scan
CHEST X-RAY INTERPRETATION
There is upper lobe predominant bronchial wall thickening with ring shadows and patches of consolidation.
There are features of mild airflow obstruction with flattened hemidiaphragms.
The features suggest cystic bronchiectasis and given the symmetrical upper lobe predominance and clinical features, cystic fibrosis (CF) is most likely.
This more clearly demonstrates the ring shadows and clear upper lobe predominance of the bronchiectasis.
CT demonstrates markedly dilated airways and thickened airway walls with sputum plugging on the right side.
Cystic Fibrosis (CF) is a multi-system respiratory and metabolic disorder that requires specialist input.
Knowledge of prior sputum cultures is vital before starting antibiotics
Chronic low weight is likely due to malabsorbtion.
CF patients with abdominal pain and features of intestinal obstruction may have Distal Intestinal Obstructive Syndrome (DIOS) – and likely need a specialist CF team, not a surgeon!