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Weekly Chest CasesArchive of Old Cases

Case No : 508 Date 2007-07-23

  • Courtesy of Kyung Min Shin, MD, Kyung Soo Lee, MD. / Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
  • Age/Sex 68 / M
  • Chief ComplaintCough and Sputum, Heart transplantation (2007.02)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Necrotizing granulomatous (Semi-invasive) aspergillus pneumonia
Radiologic Findings
Chest radiograph shows slowly gorwing multiple nodules in both lungs over 50 days. High resolution CT shows multiple nodules and mass with internal cavity formation. Transthoracic needle aspiration biopsy was performed on RUL cavitary nodule. Photomicrographs of specimen with H&E, GMS stains reveal many branching fungal organism, morphologically consistent with aspergillosis.
Brief Review
Semi-invasive aspergillosis, also known as chronic necrotizing aspergillosis, is characterized at histologic analysis by the presence of tissue necrosis and granulomatous inflammation. Factors associated with the development of this form of aspergillosis include underlying pulmonary disease such as chronic obstructive lung disese, a history of pulmonary tuberculosis, cystic lung disease, pneumoconiosis and mild systemic immunodeficiency such as diabetes mellitus, malnutrition. alcoholism, advanced age, prolonged corticosteroid therapy.
Clinical symptoms are often insidious and include chronic cough, sputum production, fever, and constitutional symptoms. Hemoptysis has been reported in 15% of affected patients.
Radiologic manifestations of semi-invasive aspergillosis include unilateral or bilateral segmental areas of consolidation with or without cavitation or adjacent pleural thickening, and multiple nodular areas of increased opacity. The fidings progress slowly over months or years.
References
1. Binder RE, Faling LJ, Pugatch RD, Mahasen C, Snider GL. Chronic necrotizing pulmonary aspergillosis: a discrete clinical entity. Medicine 1982; 61:109-124.
2. Franquet T, M?ler NL, Gim?ez A, Domingo P, Plaza V, Bordes R. Semiinvasive pulmonary aspergillosis in chronic obstructive pulmonary disease: radiologic and pathologic findings in nine patients. AJR Am J Roentgenol 2000; 174:51-56.
3. Gefter WB, Weingrad TR, Epstein DM, Ochs RH, Miller WT. Semi-invasive pulmonary aspergillosis. Radiology 1981; 140:313-321.
4. Su Young Kim, Kyung Soo Lee, Joungho Han, Jhingook Kim, Tae Sung Kim, Sung Wook Choo, and Sang Jin Kim. Semiinvasive pulmonary aspergillosis: CT and pathologic findings in six patients. AJR Am J Roentgenol 2000; 174: 795 - 798.
Keywords
Lung, Infection, Fungal infection, Immunocompromised,

No. of Applicants : 46

▶ Correct Answer : 13/46,  28.3%
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Yashodha Hospital, Hyderabad, Andhra Pradesh, India Satish Babu, Maddkuri
  • - Registrar in Radiology, UHL NHS Trust, UK. A. Donuru
  • - Apollo hospital, new delhi, India Lubna Habib
  • - Yongsan Hospital, College of Medicine Chung-Ang University, Korea Jae Seung Seo
  • - Mumbai , India Rahul B Deshmukh
  • - Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
  • - IRSA La Rochelle, France Jean-Luc BIGOT
  • - Homs National Hospital, Homs - Syria Rami Abou Zalaf
  • - Ondokuz Mayis University, Samsun Turkey Cetin Celenk
  • - CHU Saint-etienne, France Stepanois Nord
  • - Annecy Hospital, France Olivier Segall
  • - Jackson Memorial Hospital, Miami, USA N.B.S. Mani
▶ Correct Answer as Differential Diagnosis : 17/46,  37.0%
  • - Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - CHRU Lille hopital calmette, France Toledano Manuel
  • - E-Da Hospital, Taiwan Yu-Feng Wei
  • - Hospital Sotiria Athens Greece Kaith Delaveri
  • - Aarthi Advanced CT and MRI scan, Tirunelveli, India Sivasubramanian Srinivasan
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - EKH-Berlin, Germany Michael Weber
  • - NUH, nottingham, UK Rohit Kochhar
  • - Armidale Radiology, Australia Saurabh Khandelwal
  • - Hospital Sotiria, Athens, Greece Vasilios Tzilas
  • - IRSA, La Rochelle, France Denis Chabassiere
  • - Annecy hospital, France Gilles Genin
  • - Zulekha Hospital, Dubai, Australia Julie Arora
  • - China Medical University Hospital, Taiwan Jun-Jun Yeh
  • - Ultracare Coimbatore, India Debabrata Das
  • - CHU Grenoble, France Bing Fabrice
  • - Max Hospital, New Delhi, India Vickrant Malhotra
▶ Semi-Correct Answer : 15/46,  32.6%
  • - Kyungpook national university hospital, Korea Ju-wan Choi
  • - Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
  • - Aditya Imaging centre, Sayajigunj, Vadodara, Gujarat, India Vivek Patel
  • - Anandnagar, Hingne Khurd, Pune, India Bankim J.Amin
  • - Scienze Radiologiche, Parma, Italy M. Zompatori
  • - KAUMS, Kashan, Iran Ebrahim Razi
  • - National Taiwan University Hospital, Taipei, Taiwan Chin Chung Shu
  • - Osaka University, Japan Osamu Honda
  • - Regional Imaging Riverina, Australia Rashid Hashmi
  • - Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
  • - Ewha Womans University MokDong Hospital, Korea Yoo Kyung Kim
  • - CHU, Grenoble, France Pierre-Yves Savoye
  • - Dept. of Radiology, Seoul National University Hospital, Korea Kwang Nam Jin
  • - Vital imaging centre, Mumbai, India Ganesh Agrawal
  • - Dpost Gramdite Institute of Medical Education and Research, Pgimer, Chandigarh, India Krishna prasad
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