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Incidental CT Findings in a Patient with Influenza Type A, Admitted to the Hospital After a Syncopal Episode

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Authors
Marjorie P. Zambrano, MD
Richmond University Medical Center


Case

A 58-year-old male with a past medical history of Acute Coronary Syndrome (ACS), presented to the emergency department (ED) with the chief complaint of syncope. Patient also endorsed that he was experiencing cough and fever for the past 48 hours.

On the admission day, the patient was coughing repeatedly at home. After a vigorous cough he had a syncopal episode. Right after this, the patient was brought to the emergency department (ED) and admitted for syncope workup.

Due to the patient's cough and fever, a chest x-ray was taken to rule out any infectious respiratory process, and a viral panel was performed as well. An abnormality was noted in the right bronchi (Figure 1). The shape of the right bronchi was distorted, and much more dilated in comparison with the left bronchi; which prompted us to order a computed tomography (CT) of the chest.

The computed tomography (CT) scan (Figures 2 and 3) showed suspicion for pneumomediastinum. From the right mainstem bronchus, there was a projection noted medially into the mediastinum, and there were small rounded air collections adjacent to the right main bronchi. The differential at the time was pneumomediastinum vs diverticula.

Repeated chest x-ray 5 hours after the first one was taken, it showed no active disease. It did not demonstrate progression of suspected pneumomediastinum, and bronchial diverticula was confirmed. The patient was monitored at all times with a SatO2 of 98-99% on room air and in no respiratory distress.

The patient was a non-smoker and did not take any medications or use illicit drugs. The patient was admitted for further workup for syncope, and Oseltamivir was started for Influenza type A.

Chest X-Ray
Figure 1. An abnormality in the right main bronchi on a chest x-ray (Red arrow), right main bronchi seems widened.
Computed Tomography
Figure 3. Computed tomography (CT) of the thorax in axial plane demonstrating the projection or outpouching from the right mainstem bronchus (red arrow)

On the physical exam, the chest wall was symmetric, without deformity. No tenderness was appreciated upon palpation of the chest wall. The patient did not exhibit signs of respiratory distress; and normal heartbeat and breath sounds were heard upon auscultation. The patient denied chest pain, and shortness of breath.

Laboratory evaluation was unremarkable, but serology revealed that the patient was positive for Influenza type A.


Question

What is a serious condition that bronchial diverticula can mimic?

A. Pneumothorax
B. Pulmonary edema
C. Pneumomediastinum
D. Cystic Fibrosis

Answer