Cystic lung disease as a complication of post-tuberculosis infection in young patients: A rare manifestation of a common disease.

Tuberculosis (TB) is a common disease which is still endemic in many countries including Malaysia. Acquired cystic lung disease is a rare complication of post-TB infection. We aim to describe two cases of young patients who developed cystic lung disease during treatment for TB, which were further complicated with recurrent pneumothorax. We reiterate the need to consider TB in the differential diagnoses of cystic lung disease in the appropriate clinical context.

Osteonecrosis as the presenting feature in a child with acute lymphoblastic leukaemia.

A seven-year-old girl presented with pain in multiple joints and constitutional symptoms over a period of four months. There were no significant clinical findings apart from joint tenderness. Blood test results did not indicate any specific pathology and initial radiology imaging was normal. Subsequent careful examination of her X-ray images led to an MRI of her left knee, which revealed acute osteonecrotic changes. A following whole-body MRI examination demonstrated multifocal bony lesions. Bone marrow examination conclusively diagnosed acute lymphoblastic leukaemia (ALL). Acute osteonecrosis has classically been described as a complication of treatment in children with ALL and has not been recognised as a presenting feature until recently.

Lung adenocarcinoma with mixed solid and crazy-paving appearances.

"Crazy paving" on CT images refers to the superimposition of ground-glass opacity and linear pattern resembling irregularly shaped paving stones. Initially, "crazy paving" was described as a pathognomonic sign of alveolar proteinosis. Subsequently, this pattern has been reported in a variety of disorders of the lung. We demonstrated CT images of lung adenocarcinoma demonstrating both solid and crazy-paving appearances.

Lymphocytic interstitial pneumonia with tiny cysts of peribronchovascular distribution on CT.

Cysts are a common finding of lymphocytic interstitial pneumonia (LIP) on imaging. Usually, they are limited in number and size. Tiny and numerous cysts of peribronchovascular distribution are less typical but a recognized appearance in LIP.

Unilateral Nonconfluent Cluster of Micronodules: Atypical Radiologic Appearance of Pulmonary Tuberculosis in an Immunocompetent Patient.

Active pulmonary tuberculosis involving the lung parenchyma is typically seen on CT as consolidation, centrilobular nodules with tree-in-bud branching, cavitating lesions, and miliary nodules. However, some atypical CT patterns of granulomatous disease including tuberculosis have been recently described, namely, clusters of nodules without confluence or with confluence. We present a case of a patient who was found to have nonconfluent clusters of micronodules in the right lung with negative sputum culture for tuberculosis. There were also incidental findings of the partial duplex system of the left kidney with mild-to-moderate hydronephrosis in the lower moiety with proximal hydroureter. The urine culture was then positive for mycobacterium tuberculosis; hence, he was commenced on antituberculous medications. A repeated CT scan revealed significant improvement of the aforementioned clusters of micronodules and left hydronephrosis. In the present case, we would like to highlight the atypical appearances of pulmonary tuberculosis in the form of nonconfluent micronodules on HRCT despite negative sputum workup, with the concurrent active genitourinary tuberculosis.

Metastatic Adenocarcinoma Presenting as Extensive Cavoatrial Tumor Thrombus.

The presence of tumor thrombus in the right atrium is frequently the result of direct intraluminal extension of infra-diaphragmatic malignancy into the inferior vena cava (IVC) or supradiaphragmatic carcinoma into the superior vena cava (SVC). Right atrial tumor thrombus with extension into both SVC and IVC has not been reported in the literature. We present a patient who presented with symptoms of right atrial and SVC obstruction. Imaging revealed presence of a thrombus in the right atrium, extending to the SVC and IVC, with the additional findings of a left adrenal mass and multiple liver lesions. The histopathological examination of the right atrial mass revealed metastatic adenocarcinoma cells. The patient was given a presumptive diagnosis of metastatic adenocarcinoma, most likely adrenal in origin, with multiple hepatic lesions suspicious for metastasis. The clinical outcome of the patient was not favorable; the patient succumbed before the adrenal mass could be confirmed to be the primary tumor. This case highlights that in patients manifesting with extensive cavoatrial thrombus as, the existence of primary carcinoma should be considered especially in the adrenal cortex or in the lung.