RADIOLOGY OF THE MONTH

By
Hazem Moharram
Radiology Department, Cairo University

A 53-year-old woman, a known asthmatic since childhood, presented with a history of worsening cough without sputum production or weight loss and exertional breathlessness of 6 months' duration. There was no history of fever, chest pain, or hemoptysis, yet she had an old tuberculosis infection. She had a past history of chronic sinusitis. She is on no medication currently. There is no family history of respiratory disease or immune disorder.  She is slender, has mild tachypnea, and a temperature of 38. Examination of the respiratory system revealed diffuse expiratory polyphonic wheeze. The rest of the physical examination was unremarkable. Therefore, multislice CT was requested and showed bilateral high-attenuation pulmonary lesions.
Laboratory investigations showed a WBC count of 24,400/mm3 with 70% neutrophils and 5% eosinophils. IgE level is 7820 IU/ml (normal 0-120 IU/ml), erythrocyte sedimentation rate is 95 mm/hr. She had a positive skin prick test (SPT). Bronchoalveolar lavage cell count is 440 white cells/mm; with 41% neutrophils and 4% eosinophils. Special stains for acid fast bacilli and fungi are negative.

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