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Weekly Chest CasesArchive of Old Cases

Case No : 1139 Date 2019-08-28

  • Courtesy of Yeon Jung Jang, Soyeoun Lim, Woon-Jung Kwon / Ulsan University Hospital
  • Age/Sex 48 / M
  • Chief Complaintchest discomfort
  • Figure 1
  • Figure 2

Diagnosis With Brief Discussion

Diagnosis
Mediastinal aspergillus lymphadenopathy
Radiologic Findings
Figures 1-2. Conglomerated, enlarged lymph nodes with central necrosis and peripheral rim enhancement in the subcarinal region.
Figure 3. Endobronchial ultrasonography (EBUS) guided aspiration biopsy for the subcarinal lymphadenopathy. (HE x200) Fungal hyphae has been identified.

Figure 3

Brief Review
Invasive aspergillosis is a disease known to manifest mostly in immunocompromised hosts but also infrequently appears in immunocompetent individuals. It is an opportunistic airborne disease occurring predominantly in the lungs, although dissemination to virtually any organ is possible.
Early invasive pulmonary aspergillosis in CT radiography is often represented by segmental areas of consolidation or nodules with surrounding ground-glass opacities, corresponding to surrounding hemorrhage. After a patient has been treated, cavitation (the air crescent sign) may also develop within the pulmonary nodules.
Mediastinal invasion of aspergillosis is very uncommon and isolated lymphadenopathy is also very rare. Therefore, there are few studies on the image pattern of mediastinal invasion of or lymphadenopathy during aspergillosis and histopathological confirmation is essential.
Optimal management of aspergillosis involves early diagnosis and early initiation of antifungal therapy. Surgery and reduction of immunosuppression are also important adjunctive management components in selected patients.
References
1. Invasive Aspergillosis in an Immunocompetent Host.
JK SCIENCE Vol. 6 No. 2, April-June 2004
2. Invasive Aspergillosis of the Mediastinum and Left Hilum: CT Features.
American Journal of Roentgenology. 2004;183: 1224-1226.
3. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America.
Clinical infectious diseases. 2016 Aug 15; 63(4): e1–e60.
Keywords
Mediastinum, Lymph node, Aspergillosis,

No. of Applicants : 61

▶ Correct Answer as Differential Diagnosis : 5/61,  8.2%
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - Samsung Medical Center , Korea (South) MIN A LEE
  • - , Korea (South) JANG SEONG WON
  • - VENKATESHWAR HOSPITAL NEW DELHI , India RAKESH BHATIA
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