The #xrayoftheweek is this chest x-ray of a young man with a long term condition. What are the signs on the x-ray and what is the differential for the underlying diagnosis?
The lung volumes are preserved. There are marked changes of bronchiectasis, with tram-tracks (dilated and thick-walled airways seen longitudinally) and thick rings (dilated and thick-walled airways seen end on) observed in all zones of both lungs. Many of the dilated bronchi are filled with mucus, giving the "finger in glove" sign. This is an axial CT image, showing the airway dilatation and also the "signet ring" sign which is a pulmonary arterial branch next to a dilated airway in cross section. The vessel and airway should normally be approximately the same diameter.
There are a number of causes of bronchiectasis, detailed in this article. In this particular case, the cause is cystic fibrosis. Other causes in young people include Kartagener's syndrome and congenital cystic bronchiectasis.