A 55-year-old woman with long-standing chronic lung disease and episodes of acute bronchitis complains of increasing sputum production, which now occurs on a daily basis. Sputum is thick, and daily sputum production has dramatically increased over several months. There are flecks of blood in the sputum. The patient has lost 8 lb. Fever and chills are absent, and sputum cultures have not revealed specific pathogens. Chest x-ray and CT chest are shown below. Which of the following is the most likely cause of the patient’s symptoms?
A. Pulmonary tuberculosis
While symptoms such as sputum production and cough are nonspecific, particularly in a patient with known chronic lung disease, the high volume of daily sputum production suggests bronchiectasis. In this process, an abnormal and permanent dilatation of bronchi occurs as the muscular and elastic components of the bronchi are damaged. Clearance of secretions becomes a major problem, contributing to a cycle of bronchial inflammation and further deterioration. High-resolution CT scan, the diagnostic test of choice for this disease, shows prominent dilated bronchi and the signet ring sign of a dilated bronchus adjacent to a pulmonary artery. This CT scan picture is pathognomonic for bronchiectasis. Tuberculosis usually causes upper lobe cavitary disease. COPD causes hyperexpansion, upper lobe bullae, and nonspecific bronchial wall thickening. CT scan in anaerobic lung abscess would show an air-fluid level, usually within a shaggy inflammatory infiltrate. This CT scan shows no nodule or mass to suggest lung cancer.