Dry cough with abnormal airway connection

A 69-year-old man of Indian origin presented to the chest clinic with an excessive dry cough for 3 months. He did not report any weight loss, haemoptysis or fever. He had no history of recurrent cough, asthma, tuberculosis (TB) or close TB contact. He denied any nasal symptoms or significant reflux-related symptoms. He was known to have diabetes, hypertension and dyslipidaemia. Systemic examination was unremarkable. Chest X-ray was normal (figure 1A). A diagnosis of reactive airway disease was made, and inhaled corticosteroids were initiated. On follow-up after 3 weeks, his cough was no better. He denied having any fever and had a good appetite. A CT scan of the chest was requested. The CT scan showed normal lung parenchyma. However, a fistulous connection was seen between the right and left main bronchi (figure 1B,C). A bronchoscopy showed extensive ulceration and inflammation of the lower one-third...
Source: Thorax - Category: Respiratory Medicine Authors: Tags: Images in Thorax, Thorax Source Type: research