Figure 1 A-M
(A) & (B) Frontal and lateral radiographs in an 8-year-old boy demonstrate cut-off of the bronchus intermedius (arrows) and the confluent air-space process in the right lower and middle lobes
(C)-(E) Post IV contrast CT scan of the chest:
(C) Axial slice on soft tissue window at the subcarinal level demonstrates airspace disease with air-bronchograms and enhancing lung tissue (star), foci of non-enhancement (white arrows) indicating non-viable lung tissue as well as subcarinal lymphadenopathy (black arrow) and narrowing of the bronchus intermedius.
(D) Axial slice on soft tissue window at the level of the right base demonstrates a confluent area of necrosis (star) without visible lung structures, which does not contain gas and measures 15 HU, in keeping with complex necrotic fluid material. A small effusion is appreciated medial to the right crus of the diaphragm.
(E) Coronal Minimum Intensity Projection (MinIP) reconstruction angles along the airway demonstrates the cut-off of the bronchus intermedius (arrow) and dense right basal consolidation.
(F) Bronchoscopy images: Bronchoscopy images of bronchus intermedius demonstrating complete obstruction of the airway with a yellow appearing lesion with external compression of the airway.
(G) Bronchoalveolar lavage showing a small sulphur granule in a rather degenerate background (pap stain 200x).
(H) Bronchoalveolar lavage showing a higher magnification image of the sulphur granule being made up of numerous entangled filamentous bacteria.
(I) Biopsy of the bronchial mucosal sulphur granule showing a small granule surrounded by neutrophils and condensation of the bacteria on the surface being highlighted as a darker staining colour (H&E stain, 200x).
(J) Higher magnification showing the granule being composed of filamentous bacteria, similar to Figure 1H (H&E stain, 1000x).
(K) Brown-Hopps stain highlighting these bacteria as gram-positive. (Brown-Hopps gram, 1000x).
(L) PAS stain also staining the bacteria (PAS stain, 1000x)
(M) Gram stain showing abundant polymorphonuclear leucocytes, and filamentous gram-positive bacilli (Gram stain, 1000x)