Sugeesha Wickramasinghe

An 81-year-old ex-smoker presented with intermittent dry cough for 6 months and weight loss. He worked as a military engineer and had occupational exposure to coal, copper and sand. There was no history of fever, chest pain or haemoptysis. He was investigated with a chest X-ray (CXR) which showed persistent right upper zone nodular infiltrates. He was further investigated with a CT scan which revealed tree-in-bud changes, cavities and bronchial obstruction (Figure 1).

A 60-year-old non-smoker presented with a 10-day history of slurred speech and difficulty in swallowing. He denied any respiratory symptoms. On examination, there was unilateral ptosis, and he was suspected to have bulbar weakness. He was diagnosed with oculo-bulbar Myasthenia Gravis. A computed tomogram of the chest, abdomen, and pelvis was done to rule out malignancy and to rule out paraneoplastic manifestations.

This clinical image highlights a case of pulmonary artery stump thrombosis in a 68-year-old male with a history of left upper lobectomy for squamous cell carcinoma in 2019, who was under annual CT surveillance. In January 2023, he presented with a productive cough and haemoptysis. An initial surveillance CT thorax excluded cancer recurrence but revealed right upper lobe inflammatory changes (Figure 1), treated with doxycycline. However, persistent haemoptysis necessitated a CT pulmonary angiogram.