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Hypothesis on the Evolution of Cavitary Lesions in Nontuberculous Mycobacterial Pulmonary Infection: Thin-Section CT and Histopathologic Correlation

¹ Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Gangnam-Ku, Seoul 135-710, South Korea.
² Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.
³ Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.

View larger version (86K): [in a new window]   Fig. 1A. —64-year-old man with Mycobacterium avium-intracellulare complex pulmonary infection. Coronal reformation CT image (2-mm collimation) shows cavitary mass with feeding bronchus appearance (arrowheads) in left upper lobe.

View larger version (119K): [in a new window]   Fig. 1B. —64-year-old man with Mycobacterium avium-intracellulare complex pulmonary infection. Axial thin-section CT scan (2.5-mm collimation) obtained at thoracic inlet level shows cavitary mass. Note bronchiolar wall thickening with ectatic change (arrows).

View larger version (120K): [in a new window]   Fig. 1C. —64-year-old man with Mycobacterium avium-intracellulare complex pulmonary infection. Photograph of gross specimens from left upper lobectomy shows large necrotic cavitary masses (stars). Note centrally located ectatic bronchi running into cavitary masses (feeding bronchus appearance) (arrows). These gross findings suggest segmental destruction of bronchi forming necrotic cavities or focal cystic bronchiectasis. Scale = centimeters.

View larger version (133K): [in a new window]   Fig. 1D. —64-year-old man with Mycobacterium avium-intracellulare complex pulmonary infection. Photomicrograph of histopathologic specimen shows thickened membranous bronchiole (arrowheads) owing to inflammatory cell infiltration. Also note granuloma with central caseating necrosis (arrow) at end of thickened bronchiole. (H and E, x12)

View larger version (146K): [in a new window]   Fig. 1E. —64-year-old man with Mycobacterium avium-intracellulare complex pulmonary infection. Photomicrograph of histopathologic specimen shows bronchiolar lumen is diffusely narrowed by bronchiolar wall thickening (arrows) owing to transmural lymphoplasma cell infiltration. (H and E, x40)

View larger version (88K): [in a new window]   Fig. 2A. —52-year-old woman with Mycobacterium avium-intracellulare complex pulmonary infection. Transaxial thin-section CT scan (2.5-mm collimation) shows large cavitary consolidation in right lower lobe superior segment. Note proximal and distal thickened bronchus (arrowheads) around cavitary consolidation.

View larger version (84K): [in a new window]   Fig. 2B. —52-year-old woman with Mycobacterium avium-intracellulare complex pulmonary infection. Transaxial thin-section CT scan shows another large cavitary consolidation with feeding bronchus (arrow) in right lower lobe.

View larger version (189K): [in a new window]   Fig. 2C. —52-year-old woman with Mycobacterium avium-intracellulare complex pulmonary infection. Photomicrograph shows cross-sectional view of segmental bronchi of right lower lobectomy specimen. Note irregular bronchial wall thickening owing to inflammation and fibrosis resulting in luminal narrowing. Also note destruction and displacement of bronchial cartilages (arrows) and intraluminal necrotic debris (arrowhead). (H and E, x1)

View larger version (130K): [in a new window]   Fig. 3. —66-year-old woman with Mycobacterium avium-intracellulare complex pulmonary infection with multiple feeding bronchi. Transaxial thin-section CT scan (2.5-mm collimation) obtained at left main bronchus level shows multiple cavitary nodules in left upper lobe. Note multiple feeding bronchi (arrowheads) that are thickened and ectatic and running into cavitary nodules.

View larger version (111K): [in a new window]   Fig. 4A. —57-year-old man with Mycobacterium avium-intracellulare complex pulmonary infection with follow-up CT scans. Transaxial thin-section CT scans (2.5-mm collimation) show multiple cavitary nodules in both lungs. Note feeding bronchi that are thickened and ectatic and running into cavitary nodules (arrows).

View larger version (102K): [in a new window]   Fig. 4B. —57-year-old man with Mycobacterium avium-intracellulare complex pulmonary infection with follow-up CT scans. Transaxial thin-section CT scans (2.5-mm collimation) show multiple cavitary nodules in both lungs. Note feeding bronchi that are thickened and ectatic and running into cavitary nodules (arrows).

View larger version (112K): [in a new window]   Fig. 4C. —57-year-old man with Mycobacterium avium-intracellulare complex pulmonary infection with follow-up CT scans. Transaxial thin-section CT scan shows multiple small centrilobular nodules in right lower lobe superior segment. Note feeding bronchus that is mildly thickened and ectatic and running into one of the centrilobular nodules (arrowheads).

View larger version (110K): [in a new window]   Fig. 4D. —57-year-old man with Mycobacterium avium-intracellulare complex pulmonary infection with follow-up CT scans. Transaxial thin-section CT scan obtained 6 months after C shows increased size of centrilobular nodules with tiny cavitation (arrowheads).

View larger version (103K): [in a new window]   Fig. 4E. —57-year-old man with Mycobacterium avium-intracellulare complex pulmonary infection with follow-up CT scans. Transaxial thin-section CT scan obtained 11 months after D shows increased size of centrilobular nodules with larger cavitation. Also note feeding bronchus (arrowheads) and other thickened ectatic bronchi around cavitary nodules.

View larger version (101K): [in a new window]   Fig. 5A. —65-year-old woman with Mycobacterium avium-intracellulare complex pulmonary infection with follow-up CT scans. Transaxial thin-section CT scan (2.5-mm collimation) shows peribronchial nodule in right lower lobe. Note tiny central radiolucency (arrowheads) within nodule, which represents central bronchiole.

View larger version (110K): [in a new window]   Fig. 5B. —65-year-old woman with Mycobacterium avium-intracellulare complex pulmonary infection with follow-up CT scans. Transaxial thin-section CT scan obtained 6 months after A shows increased size of peribronchial nodule. Note centrally located bronchiole, which gets out of nodule and runs peripherally (arrow).

View larger version (117K): [in a new window]   Fig. 5C. —65-year-old woman with Mycobacterium avium-intracellulare complex pulmonary infection with follow-up CT scans. Transaxial thin-section CT scan obtained 12 months after B shows increased size of peribronchial nodule with focal cystic bronchiectasis, manifesting as large cavitary nodule. Note distal thickened ectatic bronchus (arrows).

View larger version (20K): [in a new window]   Fig. 6. —Schematic illustration shows hypothesis about development and evolution of bronchiectasis and centrilobular nodules with or without cavitation and large cavitary lesions in nontuberculous mycobacterial pulmonary infection.

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