대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Mediastinal aspergillus lymphadenopathy

Radiologic Findings

Figures 1-2. Conglomerated, enlarged lymph nodes with central necrosis and peripheral rim enhancement in the subcarinal region.
Figure 3. Endobronchial ultrasonography (EBUS) guided aspiration biopsy for the subcarinal lymphadenopathy. (HE x200) Fungal hyphae has been identified.

Figure 3

Brief Review

Invasive aspergillosis is a disease known to manifest mostly in immunocompromised hosts but also infrequently appears in immunocompetent individuals. It is an opportunistic airborne disease occurring predominantly in the lungs, although dissemination to virtually any organ is possible.
Early invasive pulmonary aspergillosis in CT radiography is often represented by segmental areas of consolidation or nodules with surrounding ground-glass opacities, corresponding to surrounding hemorrhage. After a patient has been treated, cavitation (the air crescent sign) may also develop within the pulmonary nodules.
Mediastinal invasion of aspergillosis is very uncommon and isolated lymphadenopathy is also very rare. Therefore, there are few studies on the image pattern of mediastinal invasion of or lymphadenopathy during aspergillosis and histopathological confirmation is essential.
Optimal management of aspergillosis involves early diagnosis and early initiation of antifungal therapy. Surgery and reduction of immunosuppression are also important adjunctive management components in selected patients.

References

1. Invasive Aspergillosis in an Immunocompetent Host.
JK SCIENCE Vol. 6 No. 2, April-June 2004
2. Invasive Aspergillosis of the Mediastinum and Left Hilum: CT Features.
American Journal of Roentgenology. 2004;183: 1224-1226.
3. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America.
Clinical infectious diseases. 2016 Aug 15; 63(4): e1

Keywords

Mediastinum, Lymph node, Aspergillosis,