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Weekly Chest CasesArchive of Old Cases

Case No : 1122 Date 2019-04-30

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  • Courtesy of Jong Eun Lee, Yun-Hyeon Kim / Chonnam National University Hospital
  • Age/Sex 57 / M
  • Chief Complaintfever, underlying DM
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Airway invasive aspergillosis
Radiologic Findings
Initial chest radiograph reveals prominent bronchovascular marking on right upper and lower lung fields. Lung window setting axial chest CT image shows marked bronchial wall thickenings with multifocal ill-defined centrilobular nodules in the both lungs, especially, in right upper lobe and right lower lobe. Follow-up chest radiogram after 10 days shows that the extent of preexisting lesions increases and peribronchial consolidation is newly formed around it, especially in right upper lung field. Lung window setting axial chest CT image taken on same day shows that multifocal peribronchial and nodular consolidations, and bronchiectasis in both lungs. Especially, there is a newly appeared ulcerative plaques along right upper lobe segmental bronchi. On bronchoscopy, whitish jelly-like patch materials and ulcerations were shown in the upper lobar bronchi and biopsy was performed. Pathologically, invasive aspergillosis was confirmed.
Brief Review
Airway invasive aspergillosis usually occurs in immunocompromised neutropenic patients, particularly AIDS patients. It accounts for approximately 15% of cases of invasive aspergillosis in immunocompromised patients. It is histologically characterized by the presence of Aspergillus organisms deep to the airway basement membrane. Clinical manifestations can vary and range from an acute tracheobronchitis, to bronchiolitis to bronchopneumonia.
The radiologic feature is characterized patchy peribronchial consolidation, bronchial wall thickening, centrilobular nodules, and, in some cases, the finding of tree-in-bud, depending on whether is it a bronchopneumonia, bronchiolitis, or tracheobronchitis. In some cases, it may be associated with bronchial and/or tracheal inflammation without invasion of the bronchial mucosa on biopsy or be associated with local invasion resulting in multiple ulcerative, plaquelike, or nodular inflammatory lesions involving the trachea, mainstem, and segmental bronchi (ulcerative tracheobronchitis), or, occasionally, result in necrosis and sloughing of the epithelium with the formation of pseudomembranes overlying the mucosal surface (pseudomembranous tracheobronchitis). Smaller airways may be involved, and this abnormality may progress to involve the lung parenchyma.
Please refer to
Case 752, Case 805, Case 871,
References
1. Franquet T, et al. Spectrum of Pulmonary Aspergillosis: Histologic, Clinical, and Radiologic Findings RadioGraphics 2001;21:825
2. Krenke R, Grabczak EM. Tracheobronchial manifestations of Aspergillus infections. ScientificWorldJournal 2011;11:2310
Keywords
Airway, Fungal, Aspergillus,

No. of Applicants : 83

▶ Correct Answer : 53/83,  63.9%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - , Korea (South) HYEYOUNG CHOI
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - Lille , France BENOIST CAPON
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Other , Korea (South) CHUNGEUN LIM
  • - Gyeongsang National University Hospital , Korea (South) HWANGHEE JO
  • - Chonnam National University Hospital , Korea (South) MOON GYEONG IL
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - , Korea (South) HYEWON CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Ajou University Hospital , Korea (South) DAYOUNG KIM
  • - , United States MAANSI P
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Dae Jin Medical Center , Korea (South) JIYOUNG CHOI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , France MARIYA RAYKOVA
  • - , Japan NAOMI YUASA
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - TB centre kasaragod. , India rikhy krishnan
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Japan YUMI MAEHARA
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 17/83,  20.5%
  • - dayanand , India REENA GUPTA
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Wuhan Union Hospital , China NANCHUAN JIANG
  • - Chonnam Nationl University Radiology , Korea (South) juwon kim
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Private sector , Greece VASILIOS TZILAS
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
▶ Semi-Correct Answer : 1/83,  1.2%
  • - , Korea (South) EUNJIN LEE
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