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Weekly Chest CasesArchive of Old Cases

Case No : 1056 Date 2018-01-22

  • Courtesy of Jae Sup Jun, Sarah Kyongmin Beck / Seoul St. Mary's hospital
  • Age/Sex 20 / M
  • Chief ComplaintNeutropenic fever with underlying hemophagocytic lymphohistiocytosis
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

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,

No. of Applicants : 100

▶ Correct Answer : 33/100,  33.0%
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - , Korea (South) HANKYUL KIM
  • - NIMS, HYDERABAD , India BHASKAR K
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) HAYEON LEE
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - , United Kingdom KRISHNA PRASAD PREMNATH BELLAM
  • - NTUH , Taiwan KUEI-PIN CHUNG
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Other , Korea (South) JIN YOUNG KIM
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) SEONGSU KANG
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Yonsei University,Severance Hospital , Korea (South) KYUNGSUN NAM
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - Sarawak General Hospital , Malaysia POHSEN TAY
  • - Other , Korea (South) HYE-JOUNG EOM
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - University of Utah , United States AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Samsung Medical Center , Korea (South) HYUN JUNG YOON
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 19/100,  19.0%
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Chonnam National University Hospital , Korea (South) MOON GYEONG IL
  • - Seoul National University Hospital , Korea (South) JAE WON CHOI
  • - Soonchunhyang University Hospital Seoul , Korea (South) SUNG HWAN BAE
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The Jikei university , Japan TAKU GOMI
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Gwangju City hospital , Korea (South) HYUNGWOO OH
  • - Gifu University Hospital , Japan Yo Kaneko
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - medical university of isfahan , Iran POOYA AKBARI
  • - , Korea (South) JIYOUNG CHOI
  • - , Korea (South) HYERIN KIM
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
▶ Semi-Correct Answer : 1/100,  1.0%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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