Date: 21 January 2014
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Image B. Additional cavities are apparent inferior to this large cavity and are in communication both with the bronchi and the additional cavities. Some of the apparent cavities are probably dilated bronchi. The left lower lung is completely opacified otherwise. The degree of pleural fibrosis surrounding the left apical cavity is reduced slightly over the interval of four months.
Image C. This shows an almost normal hyperexpanded right lung with a very substantially contracted left lung with one large airway visible and probably incontinuity with a slightly irregular cavity containing some debris, presumably fungal tissue. Other levels show very large left apical cavity with numerous subsections containing debris or fibrotic tissue and almost complete fibrosis of the lung below the level of the carina on the left, with some calcification within the fibrotic lung tissue.
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Mr RM is 80 and an ex-coal miner.He developed pneumoconiosis from exposure to coal dust. He also developed rheumatoid arthritis and the combination of this disease and pneumoconiosis is called Caplan’s syndrome.
His chest Xray in early 2015 shows extensive bilateral pulmonary shadowing with solid looking nodules superimposed on abnormal lung fields, contraction of his left lung with an elevated diaphragm and a large left upper lobe aspergilloma, displaying a classic air crescent. His CT scan from mid 2014 demonstrates a large aspergilloma in a cavity on the left, with marked pleural thickening around it, which is partially ‘calcified’ towards its base. Inferiorly on other images,remarkable pleural thickening and fibrotic irregular and spiculated nodules are seen, most partially calcified.
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