*17-year-old female with dyspnea and tachypnea for one week.
What is the most likely diagnosis?
Answer
Answer: Atelectasis secondary to asthma
Case Discussion:
Chest radiograph showing total atelectasis in the left lung.
Asthma is a relatively common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airway obstruction and bronchospasm. It can be acute, subacute or chronic.
Reported Radiographic features:
• Chest radiographs can be normal in up to 75% of patients with asthma.
• pulmonary hyperinflation
• bronchial wall thickening: peribronchial cuffing
• pulmonary edema (rare; usually occurs with acute asthma)
Reported HRCT features:
• bronchial wall thickening
• expiratory air trapping
• inspiratory decreased lung attenuation
• small centrilobular opacifities
• bronchial luminal narrowing: reduced bronchoarterial-diameter ratio
• subsegmental bronchiectasis
Complications:
• atelectasis
• pneumonia
• mucoid impaction of the airways
• eosinophilic lung disease (allergic bronchopulmonary aspergillosis, bronchocentric granulomatosis, Churg-Strauss syndrome)
References:
1- Lange S. Radiology of Chest Diseases. Thieme Medical Publishers. (1998)
2- Jensen SP, Lynch DA, Brown KK et-al. High-resolution CT features of severe asthma and bronchiolitis obliterans. Clin Radiol. 2003;57 (12): 1078-85.
3- Montaudon M, Lederlin M, Reich S et-al. Bronchial measurements in patients with asthma: comparison of quantitative thin-section CT findings with those in healthy subjects and correlation with pathologic findings. Radiology. 2009;253 (3): 844-53.
4- Silva CI, Colby TV, Müller NL. Asthma and associated conditions: high-resolution CT and pathologic findings. AJR Am J Roentgenol. 2004;183 (3): 817-24.
5- Park CS, Müller NL, Worthy SA et-al. Airway obstruction in asthmatic and healthy individuals: inspiratory and expiratory thin-section CT findings. Radiology. 1997;203 (2): 361-7.
6- Grenier P, Mourey-Gerosa I, Benali K et-al. Abnormalities of the airways and lung parenchyma in asthmatics: CT observations in 50 patients and inter- and intraobserver variability. Eur Radiol. 1996;6 (2): 199-206.