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Weekly Chest CasesArchive of Old Cases

Case No : 1101 Date 2018-12-03

  • Courtesy of Jongsun Lee, Woocheol Kwon / Wonju Severance Christian Hospital
  • Age/Sex 65 / M
  • Chief Complaintacute leukemia
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Invasive pulmonary aspergillosis
Radiologic Findings
Chest X-ray shows consolidation in RLLF. CT shows a 4.3 cm oval shape ill-defined subpleural non-enhancing mass with internal air density in RLL. And 3 cm irregular enhancing mass in LLL. There was no pleural effusion or enlarged mediastinal lymph nodes.
Brief Review
Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ∼240000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (SAIA, formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Recommendations of approach to the radiographic diagnosis of invasive pulmonary aspergillosis is the below;

Recommended performing a chest computed tomographic (CT) scan is whenever there is a clinical suspicion for IPA regardless of chest radiograph results (strong recommendation; high-quality evidence). Routine use of contrast during a chest CT scan for a suspicion of IPA is not recommended (strong recommendation; moderate-quality evidence). Contrast is recommended when a nodule or a mass is close to a large vessel (strong recommendation; moderate-quality evidence). Suggested a follow-up chest CT scan is to assess the response of IPA to treatment after a minimum of 2 weeks of treatment; earlier assessment is indicated if the patient clinically deteriorates (weak recommendation; low-quality evidence). When a nodule is close to a large vessel, more frequent monitoring may be required (weak recommendation; low-quality evidence).
References
1.Franquet T, Muller N, GimenezA et al. Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics 2001;21:825-837.
2. Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management.EurRespir J 2015.
3. Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis : 2016 update by the infectious disease society of america. Clin Infect Dis. 2016 Jun 29.
4. Nam H-S, Jeon K, Um S-W, et al. Clinical characteristics and treatment outcomes of chronic necrotizing pulmonary aspergillosis: a review of 43 cases. International Journal of Infectious Diseases 2010;14:6 e479-e482.
Keywords
Lung, Infection, Fungal infection,

No. of Applicants : 77

▶ Correct Answer : 34/77,  44.2%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - Niigata University , Japan ATSUSHI UEHARA
  • - radiologist, aditya imaging centre , India VIVEK PATEL
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - National cancer center hospital east , Japan SHIOTO ODA
  • - , United Kingdom SAMSON K
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - The Jikei university , Japan TAKU GOMI
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Other , Korea (South) JIYEON HAN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Kyung Hee University Medical Hospital , Korea (South) JUNHYUNG LEE
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - , Japan NAOMI YUASA
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - University of New South Wales , Australia RASHID HASHMI
  • - TB centre kasaragod. , India rikhy krishnan
  • - VENKATESHWAR HOSPITAL NEW DELHI , India RAKESH BHATIA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - , Korea (South) JONGSUN LEE
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
▶ Correct Answer as Differential Diagnosis : 29/77,  37.7%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Chonbuk National University Hospital , Korea (South) SANGHEON KIM
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - HHS , Canada S LEE
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - Ajou University Hospital , Korea (South) DAYOUNG KIM
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - , Korea (South) JANG SEONG WON
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Semi-Correct Answer : 2/77,  2.6%
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Other , Korea (South) HEE SEOK CHOI
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