A 41-year-old man previously diagnosed with asthma presented with an influenza-like illness and breathlessness. He was treated for moderate-to-severe COVID-19 and exacerbation of asthma. CT pulmonary angiography (CTPA) revealed asymmetrical peribronchovascular ground-glass infiltrates consistent with COVID-19 and right main bronchial wall thickening with high-density material thought to be consistent with mucous impaction (figure 1A). He was discharged 8 days after admission.

(A) Coronal view of CT pulmonary angiography (CTPA) performed on the first acute presentation of COVID-19 infection showing the appearance of high-density material with septations thought to be consistent with the appearance of mucous impaction associated with bronchial wall thickening in the right main bronchus (RMB). (B,C) Coronal and axial views of CTPA performed on second acute presentation with haemoptysis showing the high-density material and progression of bronchial wall thickening in the RMB. (D) Coronal view of low-dose CT chest performed 6 months after rigid bronchoscopy and foreign body extraction showing resolution of changes.

At review 4 months later, he reported ongoing breathlessness and cough productive of green sputum. …