대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 752 Date 2012-03-29

  • Courtesy of Tae Jung Kim / Seoul National University Bundang Hospital
  • Age/Sex 78 / M
  • Chief ComplaintDyspnea and fever
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Figure 1. Chest PA at day 1

Diagnosis With Brief Discussion

Diagnosis
Airway-invasive aspergillosis
Radiologic Findings
Bronchoscopic biopsy for endobronchial lesion and BAL were done at Day 10. Bronchoscopy revealed diffuse hyperemia and yellowish exudates throughout the bronchi and mucosal ulcer like lesion in the left upper lobar bronchus. Asgergillus species were found in the BAL fluid and biopsy specimen.
The patient expired at Day 14 despite the systemic anti-fungal agent Voriconazole.
Brief Review
Pulmonary aspergillosis can be subdivided into five categories: (a) saprophytic aspergillosis (aspergilloma), (b) hypersensitivity reaction (allergic bronchopulmonary aspergillosis), (c) semi-invasive (chronic necrotizing) aspergillosis, (d) airway-invasive aspergillosis (acute tracheobronchitis, bronchiolitis, bronchopneumonia, obstructing bronchopulmonary aspergillosis), and (e) angioinvasive aspergillosis.
Airway-invasive aspergillosis is characterized at histologic analysis by the presence of Aspergillus organisms deep to the airway basement membrane. It occurs most commonly in immunocompromised neutropenic patients and in patients with AIDS. In this particular case, the patient had no specific predisposing factor for invasive aspergillosis except for COPD.
Clinical manifestations include acute tracheobronchitis, bronchiolitis, and bronchopneumonia. Patients with acute tracheobronchitis usually have normal radiologic findings, but sometimes, tracheal or bronchial wall thickening may be extensive and progress rapidly as seen in this particular case. Aspergillus bronchopneumonia results in predominantly peribronchial areas of consolidation. Rarely, the consolidation may have a lobar distribution.
References
Keywords
lung, infection, fungal,

No. of Applicants : 99

▶ Correct Answer : 16/99,  16.2%
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - GwangmyeongInHospital , Korea (South) Ju Won Lee
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - Goa Medical College , India Paresh Desai
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - A.P.Chest hospital ,hyderabad , India bhaskar kakarla
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Das Allgemeine Krankenhaus Celle , Germany Davis Chiramel
  • - Asan medical center , Korea (South) Sang Young Oh
  • - SNUH , Korea (South) Euijin Hwang
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Saint Malo , France jean-baptiste Noel
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - All India Institute of medical sciences , India Justin Moses
▶ Correct Answer as Differential Diagnosis : 27/99,  27.3%
  • - Hanam sungshim hospital , Korea (South) CHANG IL KIM
  • - XiangYa hospital , China Xia Yu
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Korea university, Ansan hospital , Korea (South) In Young Choi
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - CHU NANCY , France, Metropolitan LEGOU Francois
  • - Chonnam national university hospital , Korea (South) Jang-hyeon Song
  • - Montreal , Canada Drago Le King
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - H�pital du Sacr , Canada Andrea Ojanguren
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Chonnam National Univ. Hospital , Korea (South) Jaemyeong Jo
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - IRSA , France, Metropolitan BIGOT
  • - Chonnam national univ. hospital , Korea (South) Choi Seul-Gi
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
▶ Semi-Correct Answer : 8/99,  8.1%
  • - radiologist, aditya imaging centre , India vivek patel
  • - University of British Columbia , Canada Amr Ajlan
  • - NDMVP Nashik , India Imran Jindani
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
  • - Travancore Medical College , India Chary D
  • - Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
  • - Kyung Hee University Medical center , Korea (North) Myung You
  • - UWO , Canada S Lee
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