Endobronchial Actinomycosis Associated with Broncholithiasis: CT Findings for Nine Patients
Tae Sung Kim1,
Joungho Han2,
Won-Jung Koh3,
Jae Chol Choi3,
Myung Jin Chung1,
Kyung Soo Lee1,
O Jung Kwon3,
Ju Hyun Lee1,
Sung Shine Shim1 and
Semin Chong1
1 Department of Radiology and Center for Imaging Science, Samsung Medical
Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong,
Gangnam-gu, Seoul 135-710, South Korea.
2 Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul 135-710,
South Korea.
3 Division of Pulmonary and Critical Care Medicine, Department of Medicine,
Samsung Medical Center, Sungkyunkwan University School of Medicine, 50,
Ilwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
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Fig. 1A —48-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Axial contrast-enhanced CT scan (window width, 877 H;
level, 108 H) shows 8-mm endobronchial calcified nodule (arrow) in
apical subsegment of left upper lobe. Calcified aortopulmonary lymph node
(arrowhead) is also seen.
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Fig. 1B —48-year-old man with endobronchial actinomycosis associated
with broncholithiasis. CT scan (window width, 350 H; level, 50 H) at level of
great vessels shows necrotic segmental consolidation in left upper lobe.
Multiple cavities (arrows) are seen within consolidation.
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Fig. 1C —48-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Contrast-enhanced CT scan at level of carina (window
width, 877 H; level, 108 H) shows calcified lymph nodes in precarinal and
subcarinal areas (arrows).
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Fig. 1D —48-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Contrast-enhanced CT scan at level of great vessels
(window width, 877 H; level, 108 H) shows calcified lymph node in left
mediastinum (arrowhead) and calcified granuloma in left upper lobe
(arrow), suggesting previous tuberculous infection.
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Fig. 1E —48-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Photograph of gross specimen of left upper lobectomy
shows yellowish endobronchial calcified nodule (arrow) within
thickened ectatic bronchus. Also seen is distal segmental consolidation
(arrowheads) with several abscess cavities along airways.
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Fig. 1F —48-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Photomicrograph of histopathologic specimen of
endobronchial calcified nodule after decalcification shows calcified
broncholith (B) covered with Actinomyces colony (arrows).
(Gomori's methenamine silver stain, x40)
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Fig. 1G —48-year-old man with endobronchial actinomycosis associated
with broncholithiasis. High-power photomicrograph shows numerous filamentous
structures representing Actinomyces. (Gomori's methenamine silver
stain, x400)
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Fig. 1H —48-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Photomicrograph of histopathologic specimen of distal
segmental consolidation shows abscess surrounded by granulation tissue. (H and
E, x100)
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Fig. 2A —56-year-old woman with endobronchial actinomycosis associated
with broncholithiasis. Axial contrast-enhanced CT scan (window width, 877 H;
level, 108 H) at level of bronchus intermedius shows 15-mm calcified
endobronchial nodule (arrow) obstructing lumen of superior segmental
bronchus of left lower lobe.
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Fig. 2B —56-year-old woman with endobronchial actinomycosis associated
with broncholithiasis. Axial contrast-enhanced CT scan (window width, 877 H;
level, 108 H) at level of left main bronchus shows calcified subcarinal lymph
node, suggesting previous tuberculous infection. Additional calcified lymph
nodes were also seen in left mediastinum (not shown).
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Fig. 2C —56-year-old woman with endobronchial actinomycosis associated
with broncholithiasis. CT scan at lower level (window width, 350 H; level, 50
H) shows distal segmental atelectasis. Two calcified granulomas
(arrows) are seen within consolidation.
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Fig. 2D —56-year-old woman with endobronchial actinomycosis associated
with broncholithiasis. Delayed CT scan (window width, 350 H; level, 50 H)
shows central low-attenuation area within segmental consolidation
(arrow). Area proved to be abscess at histopathologic examination of
lobectomy specimen.
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Fig. 3A —51-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Axial unenhanced CT scan (window width, 877 H; level,
108 H) shows calcified small, subcarinal lymph node (arrow),
suggesting previous tuberculous infection. Also seen is calcified precarinal
lymph node.
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Fig. 3B —51-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Axial unenhanced CT scan obtained 12 months after
A shows progressive erosion of posterior wall of right main bronchus by
adherent calcified subcarinal lymph node (arrow). Mucosal thickening
covers calcified node.
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Fig. 3C —51-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Axial unenhanced CT scan obtained 6 months after
B shows further encroachment of calcified subcarinal lymph node
(arrow) into airway, resulting in significant luminal narrowing of
right main bronchus. Mucosal thickening covers calcified node. After CT scan
had been obtained, broncholith was removed bronchoscopically, and biopsy of
overlying mucosa found endobronchial actinomycosis associated with
broncholithiasis.
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Fig. 3D —51-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Axial unenhanced CT scan obtained 3 months after
C shows residual mucosal thickening at site of stone removal
(arrow).
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Copyright © 2005 by the American Roentgen Ray Society.
