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Weekly Chest CasesArchive of Old Cases

Case No : 871 Date 2014-07-07

  • Courtesy of Dong-Hyeok Kang, Woon-Jung Kwon / Ulsan University Hospital, University of Ulsan College of Medicine
  • Age/Sex 53 / M
  • Chief Complaintcough and sputum, Hx of DM
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Airway invasive aspergillosis
Radiologic Findings
Chest PA radiograph shows multifocal ill-defined patchy and nodular consolidations along peribrochovascular bundles of the both lungs.
Chest CT shows marked bronchial wall thickenings with multifocal ill-defined consolidations and centrilobular nodules in the both lung, especially, in both lower lobes.
On bronchoscopy(Fig), whitish jelly-like patch materials were shown in the both upper lobar bronchi and biopsy was performed.

-Histochemistry/Cytochemistry; GMS positive, AFB negative
-The hyphae of Aspergillus species range in diameter from 2.5 to 4.5혻쨉m. They have septate tend to have dichotomous branching that is progressive and primarily at acute angles of about 45째.
Brief Review
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.
Clinical manifestations include acute tracheobronchitis, bronchiolitis, and bronchopneumonia. Patients with acute tracheobronchitisusually have normal radiologic findings. Occasionally, tracheal or bronchial wall thickening may be seen.
Bronchiolitis is characterized at high-resolution CT by the presence of centrilobular nodules and branching linear or nodular areas of increased attenuation having a tree-in-bud appearance. The centrilobular nodules have a patchy distribution in the lung. Aspergillus bronchopneumonia results in predominantly peribronchial areas of consolidation. Rarely, the consolidation may have a lobar distribution. 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.
The radiologic manifestations of Aspergillus bronchopneumonia are indistinguishable from those of bronchopneumonias caused by other microorganisms.
References
1. Franquet T, et al. Spectrum of Pulmonary Aspergillosis: Histologic, Clinical, and Radiologic Findings RadioGraphics 2001;21:825
Keywords
Lung, Airway, Infection, Fungal infection,

No. of Applicants : 77

▶ Correct Answer : 17/77,  22.1%
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - ssims&rc , India akhila d
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - chonnam national university hospital , Korea (South) Kim eun
  • - NIMS, HYDERABAD , India bhaskar kakarla
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Jichi Medical University Hospital , Japan Yuichiro Kawahara
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Chia Nan University of Pharmacy and Science ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
  • - Medicheck health care , Korea (South) Chae Lim
  • - NASA SCANS , India RAKESH BHATIA
  • - Private sector , Greece Vasilios Tzilas
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - privato , Italy genchi enzo
▶ Correct Answer as Differential Diagnosis : 19/77,  24.7%
  • - Govt medical college hospital , India HARIPRASAD RAMASAMY
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - GTHTM,Otteri , India Srinivasan V
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Severance hospital , Korea (South) Beomseok Sohn
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - IRSA La Rochelle , France Denis Chabassiere
  • - CHU Poitiers , France CHAN paul
  • - Centre Imagerie de Fribourg , Switzerland Benoit Rizk
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - GTHTM , India Ramesh M
▶ Semi-Correct Answer : 7/77,  9.1%
  • - university of montreal , Canada Andrei Gorgos I
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - , Korea (South) Choi Seul-Gi
  • - sahyadri speciality hospital , India kothareddy dileepreddy
  • - SNUH , Korea (South) Eui Jin Hwang
  • - Kanto Rosai Hospital , Japan tomoko sako
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
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