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Weekly Chest CasesArchive of Old Cases

Case No : 1022 Date 2017-05-29

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  • Courtesy of Da Jung Kim, Kiyeol Lee, Ji Young Choo / Korea University College of Medicine, Ansan Hospital
  • Age/Sex 35 / M
  • Chief Complaintneutropenic fever, underlying acute myeloid leukemia
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Invasive pulmonary aspergillosis
Radiologic Findings
Lung window setting of the contrast enhanced chest CT scan shows multifocal and bilateral variable-sized round areas of ground-glass attenuation surrounded by consolidative component (reversed halo sign). Serum galactomannan test was positive, and the patient showed improvement after treatment with voriconazole.
Brief Review
Aspergillosis is a serious pathologic condition caused by Aspergillus organism. It is frequently seen in immunocompromised patients, and angioinvasive aspergillosis is the most common form.
Characteristic CT findings in angioinvasive aspergillosis consist of nodules surrounded by a halo of ground-glass attenuation (halo sign) or pleura-based, wedge-shaped areas of consolidation. Although imaging findings in pulmonary aspergillosis may be nonspecific, in the appropriate clinical setting, familiarity with the CT findings may suggest or even help establish the diagnosis.
However, CT findings in angioinvasive aspergillosis can be variable and nonspecific, as was in this case. Reversed halo sign is an example. Although the reversed halo sign must be regarded as a nonspecific sign that can be encountered in many pulmonary conditions, in the context of immunosuppression, the reversed halo sign is highly suggestive of invasive fungal pneumonia, such as invasive aspergillosis or mucormycosis.
References
1. Franquet, Tom
Keywords
Lung, Invasive Pulmonary Aspergillosis,

No. of Applicants : 101

▶ Correct Answer : 38/101,  37.6%
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Soonchunhyang University Hospital Seoul , Korea (South) SUNG HWAN BAE
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Kilpauk Med college/GTHTM,tamilnadu , India SARAVANAN MANI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - trichy kapv medical college , India arivudai nambi
  • - Pusan national university hospital , Korea (South) So min Park
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - , India TEKWANI PARMANAND HOLARAM
  • - Chonnam National University Hospital, Radiology department , Korea (South) Park byung jin
  • - consultant radiologist , India DEVINDERPAL SINGH DHANOTA
  • - , Korea (South) JAECHEON OH
  • - GHICL , France MANUEL TOLEDANO
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Chungbuk National University Hospital , Korea (South) SOOJUNG LEE
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - , Korea (South) JEONGBIN PARK
  • - Other , Korea (South) SUNG HYUN YOON
  • - Chonnam National University Hospital , Korea (South) GUNSU KIM
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
▶ Correct Answer as Differential Diagnosis : 32/101,  31.7%
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Samsung medical center , Korea (South) Ran Kim
  • - Myongji Hospital , Korea (South) JONG HYUK KIM
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - Other , Korea (South) DONGHWAN KIM
  • - MCI , India TARUN KUMAR BAID
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - University of New South Wales , Australia RASHID HASHMI
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - Chonbuk National University Hospital , Korea (South) WON HYEONG IM
  • - , India SANTOSH KUMAR PADHY
  • - Other , Korea (South) SEONG SU KANG
  • - University of Utah , United States AKIHIKO SAKATA
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Seoul National University Hospital , Korea (South) SU YEON AHN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - Other , Korea (South) HAYEON LEE
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Private sector , Greece VASILIOS TZILAS
  • - NIMS, Hyderabad , India AMIT DADHANIA
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Chonnam National University Hospital , Korea (South) YOUNSU AHN
▶ Semi-Correct Answer : 15/101,  14.9%
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - Myongji Hospital , Korea (South) KYUNGHO KIM
  • - speciality medical officer , India DIVYESHKUMAR RAMNIKLAL DADHANIA
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Hospital Federico Abete , Argentina HO KYU LEE
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Chungbuk National University Hospital , Korea (South) HYEONMI RYU
  • - Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
  • - Busan National University Hospital , Korea (South) LEE YOU JIN
  • - Medicheck health care , Korea (South) Chae hun Lim
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