대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1363 Date 2023-12-05

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  • Courtesy of Mihyun Yang, Yookyung Kim / Ewha Womans University, Mokdong Hospital
  • Age/Sex 81 / M
  • Chief ComplaintKnown COVID-19 infection (confirmed 9 days ago) with persistent fever and cough
  • Figure 1
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  • Figure 8

Hospital day #1

Diagnosis With Brief Discussion

Diagnosis
COVID-19-associated pulmonary aspergillosis (CAPA)
Radiologic Findings
Fig 1 and 2. Non-contrast enhanced axial CT images obtained nine days after COVID-19 infection show bilateral ground-glass opacity (GGO) in both lungs, predominantly in peripheral and basal lungs, suggesting COVID-19 pneumonia.
Fig 3 and 4. CT images obtained at HD #11 demonstrate newly appeared poorly-defined nodules in the BUL anterior segment. Previous COVID-19 pneumonia (GGO) has been improved with large residual inflammation and fibrosis.
Fig 5-8. CT images obtained at HD #24 and HD #32 show a new cavitary nodule in RUL and increasing sizes of previous nodules with necrosis and surrounding GGO in BUL. Residual inflammation of COVID-19 pneumonia in the peripheral lung shows more interval improvement.
Brief Review
Incidence of aspergillus infection varies between 19.6% to 33.3% in patients with COVID-19, with a high mortality rate of 64.7%. The major risk factors for COVID-19-associated invasive pulmonary aspergillosis (CAPA) are direct epithelial lung injury from COVID-19, dysregulation of the immune system, use of corticosteroids and immunomodulators therapies, and comorbidities such as structural lung diseases, old age, morbid obesity, coronary artery disease, renal disease, and cancers.
The types of CAPA are classified into two forms, pulmonary and tracheobronchial forms. Common CT features of pulmonary form are generally known as consolidation, nodules, masses, and/or hemorrhagic infarction followed by cavities with air-meniscus sign. However, these signs are not sensitive or specific for CAPA, in which a consolidation pattern with or without nodules can be the only manifestation. Tracheobronchial form may occasionally be characterized by tracheal or bronchial wall thickening, while bronchiolitis presents with centrilobular nodules and branching linear or nodular areas of increased attenuation having a tree-in-bud appearance
References
1. Naranje P, Bhalla AS, Jana M, Garg M, Nair AD, Singh SK, Banday I. Imaging of pulmonary superinfections and co-infections in COVID-19. Current Problems in Diagnostic Radiology. 2022 Sep 1;51(5):768-78.
2. Feys S, Almyroudi MP, Braspenning R, Lagrou K, Spriet I, Dimopoulos G, Wauters J. A Visual and Comprehensive Review on COVID-19-Associated Pulmonary Aspergillosis (CAPA). Journal of Fungi (Basel, Switzerland). 2021 Dec 11;7(12):1067-.
Keywords

No. of Applicants : 81

▶ Correct Answer : 50/81,  61.7%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - The University of Tokyo Hospital , Japan JUN KANZAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Medanta the Medicity Gurugram Haryana India , India ANKUR GULATI
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - , Korea (South) JIN YOUNG LEE
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Yokkaichi municipal hospital , Japan HIKARI FUKUI
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - Ajou University Hospital , Korea (South) HYUNSEUNG LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - 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
  • - , Korea (South) HEONSEOK LEE
  • - Tokyo Medical and Dental University , Japan MIKIYA FUJII
  • - Mie university , Japan MIYUKO FUJITA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Mie university , Japan SHIKO OKABE
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Seoul National University Hospital , Korea (South) SUNGHO HONG
  • - , Korea (South) KIM HYE IN
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Mie University Hospital , Japan KENSUKE DOMAE
  • - Kyoto University , Japan SHO KOYASU
  • - Fukuoka university , Japan KEISUKE SATO
  • - Samsung Medical Center , Korea (South) SEONGUK KIM
  • - Chonnam Hospital , Korea (South) JAEHYUN PARK
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Shiga University of Medical Science , Japan RYO UEMURA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - , Korea (South) WONJU HONG
  • - General hospital of NingXia Medical University , China ZHAOJUN WANG
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - , Korea (South) JIN WOO YOON
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 15/81,  18.5%
  • - , Japan HIROAKI ARAKAWA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Oita university , Japan AYUMI KAMEI
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) KANGHWI LEE
  • - The University of Tokyo Hospital , Japan WATARU GONOI
  • - Osaka University , Japan AKINORI HATA
  • - OITA UNIVERSITY , Japan FUMIKA ISHITOBI
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
▶ Semi-Correct Answer : 3/81,  3.7%
  • - , Japan SHUNJIRO NOGUCHI
  • - GHICL , France MANUEL TOLEDANO
  • - Others , India PURUSHOTHAMA RAO TUMMALA
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