대한흉부영상의학회 Weekly Chest Cases

Case No : 1436 Date 2025-04-28

Courtesy of Bo Mi Gil / Bucheon St Mary's Hospital, The Catholic University of Korea
Age/Sex 35 / M
Chief ComplaintRepeated blood tinged sputum, 3 weeks ago and fever, 2 days ago.

Figure 1
Figure 2

Diagnosis With Brief Discussion

Diagnosis: Subacute invasive pulmonary aspergillosis.
Radiologic Findings: Figure 1.Chest PA shows clustered cystic bronchiectasis or cavities in BULs and Rt. Hilar area with air-fluid levels.
Figure 2.. Chest CT demonstrates multifocal
Brief Review: After hospitalization, the patient was disagnosed with HIV(+), AFB(-), TB PCR(-), galactomannan (+) through bronchoscopic aloveolar lavage and improved with the use of voriconazol and prophylactic antibiotics.
Aspergillus is a ubiquitous fungus whose clinical manifestations and prognosis after infection depend on the host's immune status. Subacute invasive pulmonary aspergillosis (SIPA) is a progressive fungal infection caused by Aspergillus spp. that primarily affects patients with mild to moderate immunosuppression. Unlike invasive pulmonary aspergillosis (IPA), which occurs in severely immunocompromised individuals, SIPA develops more insidiously and presents with overlapping features of invasive and chronic pulmonary aspergillosis(CPA). Common risk factors include corticosteroid therapy, structural lung disease, and conditions such as diabetes or chronic infections like tuberculosis (PTB)
References: 1. Alexander BD, Lamoth F, Heussel CP, Prokop CS, Desai SR, Morrissey CO, Baddley JW. Guidance on Imaging for Invasive Pulmonary Aspergillosis and Mucormycosis: From the Imaging Working Group for the Revision and Update of the Consensus Definitions of Fungal Disease from the EORTC/MSGERC. Clin Infect Dis. 2021 Mar 12;72(Suppl 2):S79-S88. doi: 10.1093/cid/ciaa1855. PMID: 33709131.
2. Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015 Mar;70(3):270-7. doi: 10.1136/thoraxjnl-2014-206291. Epub 2014 Oct 29. PMID: 25354514.
3. Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 2011;20(121):156-74.
Keywords

No. of Applicants : 64

▶ Correct Answer : 4/64, 6.3%

- Teikyo University Hospital , Japan CHIAKI SATO
- Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
- Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO

▶ Correct Answer as Differential Diagnosis : 20/64, 31.3%

- , Japan SUZUNE TSUKAMOTO
- IUHW Narita Hospital , Japan ISSEI FUKUDA
- Shiga University of Medical Science , Japan AKITOSHI INOUE
- , Italy PAOLO BALDASSARI
- , Korea (South) JIN YOUNG LEE
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- Seoul Medical Center , Korea (South) HYUK GI HONG
- University of Yamanashi , Japan TAKAAKI HASHIMOTO
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- University of Yamanashi , Japan HIROAKI WATANABE
- Hallym University Medical Center , Korea (South) JUNGMIN LIM
- Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- Seoul National University Bundang Hospital , Korea (South) YOONAH DO
- Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
- Fukuoka university , Japan KEISUKE SATO
- Kantou Rousai Hospital , Japan KAORU SUMIDA
- Toyota Kosei Hospital , Japan YUKI HAYASHI
- The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Semi-Correct Answer : 2/64, 3.1%

- University of Yamanashi , Japan HIROYUKI MORISAKA
- CHA University, CHA Bundang Medical Center , Korea (South) HWANGSEON JU

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1436 Date 2025-04-28

Discussion

No. of Applicants : 64