Date: 26 November 2013
Bilateral upper-lobe cavities in AIDS, pt PC
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Notes:
This patient, thought initially to have pulmonary aspergillosis in AIDS, has bilateral upper-lobe cavities, more marked on the left. He presented with fever, nonproductive cough and dyspnoea. Bronchoscopy yielded Aspergillus fumigatus. He refused therapy and died with progressive disease. He is reported as patient 8 in Denning DW, Follansbee S, Scolaro M, Norris S, Edelstein D, Stevens DA. Pulmonary aspergillosis in AIDS. N Engl J Med 1991; 324: 654-662.
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Mr RM is 80 and an ex-coal miner.He developed pneumoconiosis from exposure to coal dust. He also developed rheumatoid arthritis and the combination of this disease and pneumoconiosis is called Caplan’s syndrome.
His chest Xray in early 2015 shows extensive bilateral pulmonary shadowing with solid looking nodules superimposed on abnormal lung fields, contraction of his left lung with an elevated diaphragm and a large left upper lobe aspergilloma, displaying a classic air crescent. His CT scan from mid 2014 demonstrates a large aspergilloma in a cavity on the left, with marked pleural thickening around it, which is partially ‘calcified’ towards its base. Inferiorly on other images,remarkable pleural thickening and fibrotic irregular and spiculated nodules are seen, most partially calcified.
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