Aspergillus pulmonary nodules ; presentation , radiology , and histology features

Ref ID: 19574

Author:

EG Muldoon1*, I Page2, P Bishop1, DW Denning2

Author address:

1Infectious Diseases, University Hospital of South Manchester, Manchester, UK
2Mycology, University of Manchester, Manchester, UK

Full conference title:

6th Advances Against Aspergillosis 2014

Abstract:

Purpose:
Pulmonary aspergillosis has a number of different manifestations. Classically pulmonary aspergillosis
in immunocompetent patients presents as a saprophytic infection in a pre-existing cavity. However,
pulmonary Aspergillus disease can present as a nodule(s), without cavitation, which may be mistaken
for malignancy. The purpose of this study is to review the presentation, radiology and histological
features of nodules caused by Aspergillus spp.
Methods:
Sixty-eight patients who had histological features of aspergillosis on lung biopsy, from 2003-2013
were identified. These patients radiology was then reviewed. Patients with cavitating lung lesions,
aspergillomas, or those without parenchymal lung abnormalities were excluded. Patients with a
diagnosis of invasive aspergillosis were also excluded. Demographic data and laboratory data was
recorded on each patient. in addition to their clinical presentation.
Results:
Seven patients with pulmonary nodules and histology features diagnostic of aspergillosis were
identified. The mean age of the patients was 58 years (range 46-67). Five (71%) were men. The
mean Charleston co-morbidity score was 3.7 (2-6). Five patients (71%) were former smokers.
None of the patients was in receipt of immunosuppressive drugs, the mean lymphocyte count preoperatively
was 1.5 x 109/L (range 1.1-1.9, laboratory normal range 1.5-4), two patients (29%)
were mannose binding lectin deficient. Three patients (43%) did not have an elevated Aspergillus
IgG. Three patients had a single nodule identified on computerised tomography (CT), two had two
nodules and two had three nodules present. The mean size of the nodules was 2cm (range 1.3-
3.2cm), none had cavitation radiographically. Five patients had lesions in the upper lobes on CT
(four in the right upper lobe), while one patient had nodules in the right lower lobe and one in the
left lower lobe. Only one patient had significant lymphadenopathy on CT. On presentation, all the
patients complained of cough, five complained of dyspnoea, two complained of weight loss, and one
complained of haemoptysis. On histological examination, five patients underwent lung biopsy. All
five had evidence of fibrosis, granulation tissue and fungal hyphae were visualised. The remaining
two patients had bronchoscopy and broncho-alveolar lavage; inflammatory cells and branching
hyphae were identified.
Conclusion:
Pulmonary nodules are a less common manifestation of aspergillosis in immunocompetent patients.
Their natural history is not yet defined, although in this series all of the patients presented with
cough. These nodules may be difficult to distinguish from other lung pathology on CT findings
alone.

Abstract Number: 100

Conference Year: 2014

Link to conference website: http://www.AAA2014.org

New link: NULL

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