대한흉부영상의학회 Weekly Chest Cases

Case No : 963 Date 2016-04-11

Courtesy of Jee Hye Hur, Kyung Hee Lee / Seoul National University Bundang Hospital
Age/Sex 59 / F
Chief ComplaintHemoptysis for 6 weeks

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Diagnosis With Brief Discussion

Diagnosis: Aspergilloma
Radiologic Findings: Figure 1. Chest PA shows a small nodular opacity in the RUL above the right hilum.
Figures 2-5. Contrast-enhanced chest CT images show a 2cm well-defined nodule with mild peripheral enhancement in the right upper lobe. This nodule is connected to adjacent tubular low attenuating lesions.
Figure 6. This RUL nodule does not show any interval change when compared with the initial chest CT image performed 6 weeks before.
To exclude the possibility of malignancy, percutaneous lung biopsy was performed. The pathologic diagnosis of percutaneous needle biopsy revealed fungal hyphae, morphologically consistent with aspergillus species. As our patient had history of repeated hemoptysis, this patient underwent RUL posterior segmentectomy for treatment. Pathology revealed fungus ball in bronchial lumen, which was consistent with aspergilloma.
Brief Review: The nodular appearance of pulmonary aspergillosis without an air-meniscus sign has not only been reported in immunocompetent patients without underlying lung disease, but also in mildly immunosuppressed patients with underlying chronic lung diseases. It is suggested that primary aspergilloma may arise from implantation of fungus in a normal bronchus followed by gradual dilatation of bronchus by the pressure of its growing colony. The saprophytic aspergillosis in immunocompetent patients accompanied by an air-meniscus sign enables it to be distinguished from malignancy. Pulmonary aspergillosis without air-meniscus sign is seen as a non-specific solid nodule or mass on CT scans. Not only a specific diagnosis of pulmonary aspergillosis is difficult, but also differentiation from malignancy ware radiologically impossible. Therefore the pathologic evaluation by obtaining specimen using percutaneous lung biopsy is essential for the differentiation between this unique pulmonary aspergillosis and lung cancer.
References: Yoon SH, Park CM, Goo JM, et al. Pulmonary aspergillosis in immunocompetent patients without air-meniscus sign and underlying lung disease: CT findings and histopathologic features. Acta Radiologica 2011; 52: 756–761.
Kang EY, Kim DH, Woo OH, et al. Pulmonary aspergillosis in immunocompetent hosts without underlying lesions of the lung: radiologic and pathologic findings. AJR 2002;178:1395–1399.
Keywords: Airway, Infection, Fungal infection,

No. of Applicants : 117

▶ Correct Answer : 5/117, 4.3%

- Yonsei University Wonju College of Medicine , Korea (South) Ji Eun Park
- Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Medicheck health care , Korea (South) Chae Lim
- Okayama University Hospital , Japan Toshiyuki Komaki

▶ Correct Answer as Differential Diagnosis : 15/117, 12.8%

- Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
- Shiga University of Medical Science , Japan Akitoshi Inoue
- McGill University Health Center , Canada Alexandre Semionov
- Onomichi municipal hospital , Japan Hirofumi Mifune
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Kizawa Memorial Hospital , Japan Yo Kaneko
- 異⑸ , Korea (South) Junghwan Kim
- University of Tsukuba Hospital , Japan Hiroaki Takahashi
- University of Toronto , Canada Micheal McInnis
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- Avrasya Hospital , Turkey Murat Ulusoy
- NASA SCANS , India RAKESH BHATIA
- The University of Tokyo Hospital , Japan Kaoru Sumida
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Private sector , Greece Vasilios Tzilas

▶ Semi-Correct Answer : 29/117, 24.8%

- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Niigata University , Japan Atsushi Uehara
- Juntendo University Hospital , Japan Akifumi Hagiwara
- King Abdulaziz University Hospital , Saudi Arabia Amr Ajlan
- NIMS, HYDERABAD , India bhaskar kakarla
- the First Affiliated Hospital of NanJing Medical University , China Aiping Chen
- Policlinico Umberto I , Italy Paolo Baldassari
- Asan Medical Center , Korea (South) Hyung Jung Koo
- The Jikei university , Japan Taku Gomi
- university of montreal , Canada Andrei Gorgos I
- The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
- Chung buk national university hospital , Korea (South) honggwon Byun
- Chonnam National University Hospital , Korea (South) So yeon Ki
- Kyung Hee University Hospital at Gangdong , Korea (South) Han Na Lee
- chungbuk national university hospital , Korea (South) lee jung hwan
- Goa Medical College , India Paresh Desai
- Mallinckrodt Institute of Radiology , United States Naganathan Mani
- Seoul national university hospital , Korea (South) Kumju Chae
- Santosh hospital,Bengaluru , India Pravin Mahadevappa
- Pusan National University Hospital , Korea (South) Jeongbin Park
- Ajou University Hospital , Korea (South) Seulgi You
- Jangsung public clinic , Korea (South) Yongsub Song
- Kyoto University , Japan Akihiko Sakata
- stanley medical college , India yazhini v
- chungbuk university hospital , Korea (South) Hyeonmi Ryu
- Asan medical center , Korea (South) Cherry Kim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 963 Date 2016-04-11

Discussion

No. of Applicants : 117