대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Airway invasive aspergillosis

Radiologic Findings

Chest AP shows diffuse heterogeneous opacity, volume loss with hilar mass-like opacity in the left lung with blunting of left CP angle. Pre-contrast CT with mediastinal setting shows complete obstruction in the left main bronchus with total atelectasis in the left lung. Pre-contrast CT with lung setting shows nonspecific findings in the right lung. Contrast-enhanced CT with mediastinal setting shows endobronchial, non-enhancing mass in the left main bronchus with segmental bronchus. MinIP shows severe stenosis on the distal trachea and total obstruction below the left main bronchus.

Brief Review

The patient was diagnosed as DM during the admission. Bronchoscopy shows polypoid mass on the distral trachea and total obstruction on the left main bronchus. Microscopic findings of bronchoscopic biopsy specimens shows fungal hyphae with inflammatory cells.

Airway-invasive aspergillosis is characterized by the presence of Aspergillus organisms deep to the airway basement membrane (1). It usually occurs in immunocompromised neutropenic patients and in patients with AIDS (2-3). Although patients with acute tracheobronchitis usually have normal radiologic findings, tracheal or bronchial wall thickening may be seen occasionally. Type of bronchiolitis is characterized by the presence of centrilobular nodules and branching linear or nodular areas of increased attenuation having a 'tree-in-bud' appearance (1). Centrilobular nodular areas of increased opacity similar to those seen in Aspergillus bronchiolitis have been described in a number of conditions, including endobronchial spread of pulmonary tuberculosis, Mycobacterium avium-intracellulare, and viral and mycoplasma pneumonia (4). Meanwhile, obstructing bronchopulmonary aspergillosis is characterized by the massive intraluminal overgrowth of Aspergillus species, usually A fumigatus (5). Affected patients exhibit cough, fever, and new onset of asthma and present with severe hypoxemia. The characteristic CT findings in obstructing bronchopulmonary aspergillosis mimic those in allergic bronchopulmonary aspergillosis and consist of bilateral bronchial and bronchiolar dilatation, large mucoid impactions (mainly in the lower lobes), and diffuse lower lobe consolidation caused by postobstructive atelectasis (5).

Please refer to

Case 441, Case 752,

References

1. Logan PM, Primack SL, Miller RR, M체ller NL. Invasive aspergillosis of the airways: radiographic, CT, and pathologic findings.Radiology1994; 193:383-388
2. Won HJ, Lee KS, Cheon KS, et al. Invasive pulmonary aspergillosis: prediction at thin-section CT in patients with neutropenia

Keywords

Airway, Infection, Fungal infection,