THORACIC Section 4: INFECTION - Non Tuberculous Mycobacteria

Question 1

This one is usually caused by MAC. It favors an old white man with COPD (or other chronic lung disease), and it looks like reactivation TB. So you have an upper lobe cavitary lesion with adjacent nodules (suggesting endobronchial spread).

Answer 1

Cavitary (“Classic”)

Question 2

This is the so-called “Lady Windermere” disease (everyone knows it’s just not lady-like to cough). They often do not cough and are asymptomatic. This favors an old white lady. You see tree-in-bud opacities and cylindric bronchiectasis in the right middle lobe and lingula.

Answer 2

Bronchiectatic (“Non-Classic”)

Question 3

the most common manifestation in HIV patients with Non-TB mycobacteria

Answer 3

Mediastinal lymphadenopathy

Question 4

This is the so-called “hot-tub lung.” Where you get aerosolized bugs (which exist in natural sea water and in fresh water). The lungs look like ill-defined, ground glass centrilobular nodules.

Answer 4

Hypersensitivity Pneumonitis

Question 5

Non Tuberculous Mycobacteria - Rapid Review!

Old White Male Smoker

Answer 5

Cavitary Type

Question 6

Non Tuberculous Mycobacteria - Rapid Review!

Old Lady

Middle Lobe and Lingula, bronchiectasis and tree in bud.

Answer 6

Non-Classic
(Lady Windermere)

Question 7

Non Tuberculous Mycobacteria - Rapid Review!

Low CD4 (< 100)
Mediastinal Lymphadenopathy

Answer 7

HIV