Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Invasive pulmonary aspergillosis
- Radiologic Findings
- Chest X-ray shows consolidation in RLLF. CT shows a 4.3 cm oval shape ill-defined subpleural non-enhancing mass with internal air density in RLL. And 3 cm irregular enhancing mass in LLL. There was no pleural effusion or enlarged mediastinal lymph nodes.
- Brief Review
- Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect 240000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (SAIA, formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Recommendations of approach to the radiographic diagnosis of invasive pulmonary aspergillosis is the below;
Recommended performing a chest computed tomographic (CT) scan is whenever there is a clinical suspicion for IPA regardless of chest radiograph results (strong recommendation; high-quality evidence). Routine use of contrast during a chest CT scan for a suspicion of IPA is not recommended (strong recommendation; moderate-quality evidence). Contrast is recommended when a nodule or a mass is close to a large vessel (strong recommendation; moderate-quality evidence). Suggested a follow-up chest CT scan is to assess the response of IPA to treatment after a minimum of 2 weeks of treatment; earlier assessment is indicated if the patient clinically deteriorates (weak recommendation; low-quality evidence). When a nodule is close to a large vessel, more frequent monitoring may be required (weak recommendation; low-quality evidence).
- References
- 1.Franquet T, Muller N, GimenezA et al. Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics 2001;21:825-837.
2. Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management.EurRespir J 2015.
3. Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis : 2016 update by the infectious disease society of america. Clin Infect Dis. 2016 Jun 29.
4. Nam H-S, Jeon K, Um S-W, et al. Clinical characteristics and treatment outcomes of chronic necrotizing pulmonary aspergillosis: a review of 43 cases. International Journal of Infectious Diseases 2010;14:6 e479-e482.
- Keywords
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Lung, Infection, Fungal infection,