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Weekly Chest CasesArchive of Old Cases

Case No : 1383 Date 2024-04-24

  • Courtesy of Geewon Lee / Pusan National University Hospital
  • Age/Sex 85 / F
  • Chief ComplaintCough, sputum, and fever
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
COVID-19 associated pulmonary aspergillosis (CAPA)
Radiologic Findings
Figure 1. Initial chest radiograph shows ground-glass opacity (GGO) and consolidation, predominantly in peripheral lungs.
Figure 2, 3. Initial axial and coronal chest CT images show patchy GGO and consolidation predominantly in peripheral lungs, suggesting COVID-19 pneumonia.
Figure 4. Chest radiograph obtained 3 weeks later shows the appearance of a cavity in the right lung field.
Figure 5, 6. Axial chest CT images obtained 3 weeks later demonstrate a large cavity in the RUL. COVID-19 pneumonia in the peripheral lung shows interval improvement.
Brief Review
Pulmonary aspergillosis is emerging as a serious secondary infection in patients with COVID-19 and ARDS, and two studies have indicated excess mortality rates of 16% and 25% compared with patients without evidence for aspergillosis. However, it is unclear whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection itself is the main risk factor for CAPA, or whether additional risk factors, such as corticosteroid therapy, further increase the risk for disease progression.
The typical appearance of COVID-19 in patients includes peripheral, bilateral, ground-glass opacities with or without consolidation or visible intralobular lines (ie, so-called crazy paving) in early stages; multifocal ground-glass opacities of rounded morphology with or without consolidation or visible intralobular lines (ie, crazy paving) at peak stage; and reverse halo sign or other findings of organizing pneumonia at late stages.
Imaging findings of multiple pulmonary nodules or lung cavitation should prompt thorough investigation for pulmonary aspergillosis, as they are rarely seen with COVID-19 alone and have been described in a patients with CAPA.
References
Koehler P, Bassetti M, Chakrabarti A et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis. 2021 Jun;21(6):e149-e162
Keywords

No. of Applicants : 69

▶ Correct Answer : 44/69,  63.8%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - The University of Tokyo Hospital , Japan JUN KANZAWA
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - Oita university , Japan AYUMI KAMEI
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - , Korea (South) DONG-HO BANG
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - , Korea (South) KANGHWI LEE
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Other , Korea (South) HYEJOO PARK
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Nankai medical center , Japan NORITAKA KAMEI
  • - , Japan KENTARO KOTANI
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kyoto University , Japan SHO KOYASU
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Inje University Pusan Paik Hospital , Korea (South) GEOJEONG SEO
  • - , Japan YUMI MAEHARA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Osaka Red Cross Hospital , Japan YANG WANG
  • - , Korea (South) JIN WOO YOON
  • - , China LI GUO
  • - Juntendo University , Japan YUTAKA IKENOUCHI
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 12/69,  17.4%
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Uniyersity of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Mie University , Japan HIKARI FUKUI
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - Ome Medical Center , Japan MIKIYA FUJII
  • - Mie university , Japan SHIKO OKABE
  • - GHICL , France MANUEL TOLEDANO
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
▶ Semi-Correct Answer : 2/69,  2.9%
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
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