Date: 3 May 2013
High resolution CT scan images with reconstruction of 1mm thick slices at approximately 10mm increments. The scan shows moderately severe multi-lobar cylindrical and varicose bronchiectasis predominantly centrally and in the upper lungs. There is no mucus plugging seen.
The features are in keeping with allergic bronchopulmonary aspergillosis
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The chest x-ray shows a patient who had a left lung transplanted in May 2003 for cryptogenic fibrosing alveolitis, which was diagnosed post-transplant as sarcoidosis.
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Gross pathology demonstrating the great pleural thickness and two cavities (upper lobe and superior segment of lower lobe) with fragments of fungal mass.
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Histopathological appearance of a fungus ball. Note a conidial head resulting from fungal exposure to the air.
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Histopathological appearance of a fungus ball caused by Scedosporium apiospermum. The presence of anneloconidia differentiates it from Aspergillus.
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Chronic necrotising aspergillosis. Hyaline hyphal and calcium oxalate crystals obtained by needle aspirate biopsy from a diabetic patient with chronic necrotizing aspergillosis caused by Aspergillus niger (Papanicolaou, x 100).
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Aspergillus niger fungus ball and acute oxalosis. Higher magnification of adjacent replicate section.
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Oxalate crystals within renal tubuli (H&E, phase contrast, x 100). This patient developed acute oxalosis.
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Lung surface. Fungus ball, severe parenchymal fibrosis and pleural thickening.
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