대한흉부영상의학회 Weekly Chest Cases

Case No : 153 Date 2000-09-30

Courtesy of Seo Joon Beom, MD, Han Kyung Lee, MD. / Gachon Medical School Gil Medical Center, Inchon, Korea
Age/Sex 31 / F
Chief ComplaintHemoptysis

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Figure 2
Figure 3

Diagnosis With Brief Discussion

Diagnosis: Aspergilloma within ectatic bronchus, mimicking endobronchial hamartoma
Radiologic Findings: The focused image of chest radiograph shows round mass shadow in left lower zone.
Nodular or popcorn-like calcifications are seen within the mass.
Increased opacity superior to the mass shadow is due to aspirated blood.
On CT scan, the mass located within the ectatic bronchus with air crescent sign and the presence of popcorn-like calcification was confirmed.
Brief Review: A fungus ball can be defined as a conglomeration of interwined fungal hyphae admixed with mucus and cellular debris within pulmonary cavity or ectatic bronchus.
The most common underlying cause is tuberculosis, approximately 25 to 50% of patients having a history of this disease.
Other predisposing conditions associated less often with aspergilloma formation include bronchiectasis of any cause, chronic fungal cavities, bronchogenic cysts, acute and chronic bacterial abscesses, cavities related to P. carinii in patient with AIDS, cavitary carcinoma, radiation fibrosis, and so on.

Radiologically, a fungus ball consists of a solid, more or less round mass of soft tissue density within a spherical or ovoid cavity.
Typically, the mass is separated from the wall of the cavity by an air space, resulting in the distinctive air crescent sign. As on the radiographs, the most characteristic finding of aspergilloma on CT consists of an ovoid or round soft tissue intracavitary mass.
Areas of increase attenuation, presumably representing calcium deposit, are relatively common.
CT may also demonstrate fungal fronds situated on the cavity wall that intersect with each other and form an irregular sponge-like network, before the development to the mature fungus ball.
Occasionally, the mycelial mass grows to fill a cavity completely, effectively obliteration the air space necessary for its radiographic identification.
The fungus ball usually moves when the patient changes position.
Calcification of the fungus ball occurs in some cases; this may be apparent as scattered small nodules, as a find rim around the periphery of the mass, or as an extensive process involving the greater part of the mycetoma.
References: 1. Fraser and Pare's Diagnosis of diseases of the chest. 4th ed. 924-927

2. Kim TS, Lee KS, Han J, et al. Mucoepidermoid carcinoma of the tracheobronchial tree: radiographic and CT findings in 12 patients. Radiology 1999; 212: 643-648

3. Ahn JM, Im J-G, Seo JW, et al. Endobronchial hamartoma: CT findings in three patients. AJR 1994; 163: 49-50
Keywords: Lung, Airway, Infection, Fungal infection,

No. of Applicants : 33

▶ Correct Answer : 17/33, 51.5%

- 嫄닿뎅
- 寃쎈 議
- 怨紐諛
- 遺理湲곕났
- 源
- 理
- 沅寃쎌
- 源
-
- 怨듭
- 怨듭 議곕
- Lviv Regional Specialized Children's Clinic Chornobyl Problems, Ukraine Viktor I. Zhelov
- Lviv Regional Specialized Children's Clinic Chornobyl Problems, Ukraine Larissa Drobchenko
- Lviv Regional Specialized Children's Clinic Chornobyl Problems, Ukraine Rostislav Lozynsky
- Samsung Medical Center, Sungkyunkwan University Kyung Soo Lee
- Seoul National University Hospital Hyo-Cheol Kim
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate

▶ Semi-Correct Answer : 9/33, 27.3%

- 嫄곗갹
- 怨
- 源吏
- 沅
- CHU Nancy-Brabois, Vandoeuvre les Nancy cedex, France Denis REGENT
- Matsuyama Red Cross Hospital, Matsuyama, Japan Shunya Sunami
- Ospedale di Fabriano, Italy Giancarlo Passarini
- Sakuragaoka, Kagoshima city, Kagoshima, Japan Yasutaka Baba
- Seoul National University Hospital Seong Ho Park

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 153 Date 2000-09-30

Discussion

No. of Applicants : 33