AJTCCM VOL. 28 NO. 3 2022 137

PICK OF THE PICS

A 70-year-old male HIV-seronegative smoker presented with a

productive cough and dyspnoea. Clinical ndings included digital

clubbing, central cyanosis and features of cor pulmonale. Bilateral

crackles were audible on auscultation of his chest.

A high-resolution computerised tomography scan of his chest

revealed features in keeping with Mounier-Kuhn syndrome (MKS)

(congenital tracheobronchomegaly) and bilateral cystic bronchiectasis

(Fig. 1). e transverse diameter of his trachea measured 32 mm

(normal for males 13 - 25 mm).[1] MKS is characterised histologically

by atrophy of smooth muscle and elastic tissue in the tracheal and

bronchial walls. It is more common in males than females and is

usually diagnosed in the 3rd or 4th decade of life,[2] although there is

a report of a male diagnosed at 86 years of age.[3] Abnormal dilatation

of the tracheobronchial tree, oen with diverticula, causes impaired

function of the mucociliary escalator, recurrent respiratory tract

infections and bronchiectasis.[2] e vast majority of cases are sporadic.

1. Boiselle PM. Imaging of the large airways. Clin Chest Med 2008;29:181-193.

2. Simon M, Vremaroiu P, Andrei F. Mounier-Kuhn syndrome. J Bronchol Intervent

Pulmonol 2014;21:145-149.

3. Geppert EF. Recurrent pneumonia. Chest 1990;98:739-745.

This open-access article is distributed under

Creative Commons licence CC-BY-NC 4.0.

What is the cause of this patient’s chronic productive cough?

M L Wong, MB BCh, DCH(SA), FCP(SA), FCCP, FRCP(Lond)

Chris Hani Baragwanath Academic Hospital and School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand,

Johannesburg, South Africa

Fig. 1. Axial and coronal views of high-resolution computerised tomography scan demonstrating tracheobronchomegaly and bilateral cystic

bronchiectasis.