Case Report
Copyright ©The Author(s) 2017.
World J Clin Cases. Apr 16, 2017; 5(4): 153-158
Published online Apr 16, 2017. doi: 10.12998/wjcc.v5.i4.153
Table 1 Confounding factors leading to delay in diagnosis in the index case
Young age of presentation
Lack of significant soft tissue component and thin walls initially
Multifocality favoured a systemic infection/disease (vasculitis) rather than primary lung malignancy
Increase in wall thickness in second CT was suspicious, but interpretation was confounded by heavy growth of streptococcus.
Waxing and waning symptoms.
Repeated negative BAL and FOB
Table 2 Learning points
IMAC is more common in non-smokers and females and has poor prognosis
It has lower lobe predominance and is frequently multifocal
IMAC may be missed on repeated cytology and biopsies due to relative paucity of malignant cells and large amount of mucin
“Tambourine” sign in appropriate clinical setting identifies lung cavity suspicious for malignancy, especially IMAC
IMAC may show unusual slow growth and only mild uptake on PET