21st June 2024

A 90-year-old woman undergoes a routine chest radiograph (below) while being electively admitted for a surgical procedure

A 90-year-old woman undergoes a routine chest radiograph (below) while being electively admitted for a surgical procedure. She is well, is able to give a thorough history, and denies night sweats, although she has had a productive cough for as long as she can remember. The volume and severity of the cough remains unchanged. Another doctor on your team performs an interferon gamma release assay (IGRA), which is positive.

Image Source: Wikimedia Commons (2016). Pneumonolysis, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/Category:Pneumonolysis (Accessed: 24 January 2024).

Select the SINGLE most appropriate explanation for this radiological appearance from the list below. Select ONE option only.