Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Aspergillus tracheobronchitis
- Radiologic Findings
- Figs 1-4. Mediastinal window setting of the chest CT scan shows diffuse wall thickening with mild adjacent fat infiltrations in distal trachea, right main brondhus, and right bronchus intermedius.
- Brief Review
- Aspergillus tracheobronchitis (AT) accounts for less than 5% of cases of invasive pulmonary aspergillosis (IPA), mainly involves the trachea and bronchi, and is commonly seen in patients with impaired immunity, while seldom seen in immunocompetent populations. The diagnosis of AT is usually delayed because of its nonspecific clinical presentation and the lack of radiographic findings in the early stages, which results in a high mortality rate.
As regards imaging findings, the literature describes tracheal or bronchial wall thickening as the main finding. Presence of multifocal, irregular plaques on the tracheal wall, many times with high attenuation due to the Aspergillus sp capacity to fix calcium, is also described.
Transbronchial biopsy in association with sample culture presents high diagnostic accuracy, but many times it is contraindicated by the presence of thrombocytopenia or coagulopathy observed in patients affected by malignant hematological diseases.
There is no specific recommendation for the management of tracheobronchial aspergillosis. The use of voriconazol has been reported in the literature as the drug of choice, despite the disadvantage of its high cost. Thus, other anti-fungal drugs, either alone or in combination have also been quite utilized in the clinical practice.
- References
- 1. Krenke R, Grabczak EM. Tracheobronchial Manifestations of Aspergillus Infections. The Scientific World Journal. 2011;11:2310-2329.
2. Tomás Franquet, Nestor L. Müller, Ana Giménez, Pedro Guembe, Jesus de la Torre, and S. Bagué. Spectrum of Pulmonary Aspergillosis: Histologic, Clinical, and Radiologic Findings. RadioGraphics 2001 21:4, 825-837.
- Keywords
- Airway, Infection,