[A case of Mycobacterium avium pulmonary disease detected as multiple small nodular shadows and diagnosed by CT guided transbronchial biopsy with ultrathin bronchoscopy].
A 65-year-old man was admitted to our hospital because multiple small nodular shadows measuring five to 12 mm in diameter in both lung fields were noticed on chest radiographs and CT scans during a regular checkup for pulmonary emphysema. The levels of ESR and CRP were within normal limits, but those of CEA and CYFRA were slightly elevated. Mycobacterium avium (M. avium) was detected in sputum cultures and in a sputum examination using PCR. Non-necrotizing granulomas were detected in the specimens obtained from a lesion of the right S6b by CT-guided transbronchial biopsy using an ultrathin bronchoscope after navigation with virtual bronchoscopy. On the basis of these findings, M. avium pulmonary disease was diagnosed. The patient is being followed up, but because he has no symptoms, without medication. To our knowledge, there have been no previous reports of M. avium-intracellulare complex pulmonary disease, which is characterized by multiple small nodular shadows. It is speculated that multiple centrilobular lesions developed simultaneously without extension to the bronchial walls, leading in this case to multiple small nodules in both lung fields.
First Department of Medicine, Hokkaido University School of Medicine.
Kaori
K
Watanabe
Yasushi
Y
Shimizu
Satoshi
S
Oizumi
Naofumi
N
Shinagawa
Ichiro
I
Kinoshita
Koichi
K
Yamazaki
Yuya
Y
Onodera
Hiroshi
H
Saito
Etsuro
E
Yamaguchi
Hirotoshi
H
Dosaka-Akita
Masaharu
M
Nishimura
D000368:Aged; D001706:Biopsy / Q000379:methods; D001999:Bronchoscopy; D006801:Humans; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000175:diagnosis*; D008297:Male; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed