CT Scan after 130 days of treatment

Date: 3 May 2013

  • ptKS3

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CT scan day 130

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Notes:

 

This 30 yr old man with CML underwent a matched BMT from an unrelated donor. Immunosuppressive drugs plus initial antifungal therapy of fluconazole was given followed 2 weeks later with Lip AmB. Patient had persistent coughs and fevers. 
On day63 Caspofungin was given but changed to Voriconazole 200 bd on day96 as a result of worsening LFTs the dose was reduced to 200/d. On day96 progressive changes were seen on CT. On day100 concern re progressive to invasive Aspergillosis /Other mould infections? increased Voriconazole to 400/d.
Patient showed ongoing symptoms of GVHD and continued on methotrexate and cyclosporin. 
Poor LFTs at day 110 lead to change of therapy to Lip. AmB with the aim of reintroducing Voriconazole. On day 108 a bronchoscopy was performed -but no diagnosis could be reached.
Day116 repeat colonoscopy/gastroscopy showed severe architectural damage, active GVHD Ileal and colon biopsy positive for yeast spp.
Day 139 Bronchoscopy – purulent secretions in lingual and LLL, BAL fungal culture negative, PCR was + Aspergillus spp.Day 155 treatment was switched to caspofungin due to patient concern. During the next 40 days the patient was given caspofungin,voriconazole, then caspofungin followed by itraconazole which was not tolerated. On day 226 the patient died.

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Showing 10 posts of 2574 posts found.

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  • Allergic Aspergillus Sinusitis -Patient AM.

    A - The right sphenoid sinus is opacified and there is some involvement of the right ethmoids. Bony structures seem intact., B - Coronal section shows bilateral maxillary involvement with extensive mucosal thickening and some oedema of the turbinates., C - Extensive involvement of both maxillary sinuses, with soft tissue swelling. Swelling of both turbinates also visible., D - Marked involvement of ehmoidal air cells on the right , together with the inferior aspect of the sphenoid sinus. The left side is almost clear of disease.

  • Pt DP . CT scan Amphotericin B installation and aspergilloma. Chronic cavitary pulmonary aspergillosis

    Image A. Scan shows large bore needle in one of the cavities on the right. The contrast media is mixed with amphotericin B and is whiter than surrounding lung tissue and fungal ball. The contrast surrounds the aspergilloma present in this cavity. Some of the contrast has fallen by gravity in another cavity anteriorly below the one being injected, showing communication between the cavities.

    Image B. Scan showing contrast media mixed with amphotericin B injected into a multicystic cavity in the right upper lobe. The contrast (white) flows around the aspergilloma present in this cavity. The contrast falls by gravity posteriorly.

    Image C. The opposite lung shows multiple empty cystic spaces with little normal lung.

    Image D.  There is substantial pleural thickening surrounding the irregular cavity containing the aspergilloma.

    Image A. Amphotericin B installation. , Image B. Post amphotericin B installation., Image C. Scan after instillation of amphotericin B mixed with radiographic contrast medium showing debris surrounded by contrast, in an irregular large apicalcavity., Image D. Scan of chest showing a rim of contrast containing amphotericin B after injection around a large aspergilloma.

  • Allergic Broncho-pulmonary aspergillosis. Patient RT, CT scans of thorax.

    Image A. Patient with longstanding ABPA, showing some bronchiectasis in the right lung and considerable mucous plugging particularly around the main bronchi., Image B. Bilateral multilobar bronchiectasis with surrounding peribronchial oedema and some evidence of inhomogeneity of the pulmonary parenchyma on the left, with hyperexpansion, indicating chronic air trapping in the left upper lobe particularly., Images C & D. Bilateral bronchiectasis in the context of corticosteroid dependant ABPA, which improved markedly with oral itraconazole therapy., Images C & D. Bilateral bronchiectasis in the context of corticosteroid dependant ABPA, which improved markedly with oral itraconazole therapy.

  • CT scan of thorax

    Extensive multilobar, varicose bronchiectasis, with some cyst formation most marked on the left anteriorly. Also some inhomogeneity of the pulmonary parenchyma secondary to air trapping in several affected segments.

    image198

  • Pt CT severe ABPA

    CT scan of thorax

    image191

  • Pt CT severe ABPA

    CT scans of thorax. Anterior left-sided bronchiectasis with extensive mucous plugging and with some proximal bronchiectasis and plugging on the right.

    image189

  • Pt CT severe ABPA

    Bilateral multilobar varicose bronchiectasis affecting the segmental and small order bronchi, with some distal plugging.

    image188

  • Cerebral Aspergillosis -Patient KH; MR scans of Brain

    T1 weighted, gadolinium enhanced magnetic resonance brain scan. This 43 year-old alcoholic woman underwent laparoscopic cholecystectomy in January 2001. Ten days after surgery, she became confused, dysphasic and eventually had tonic-clonic seizures. A CT scan showed non-communicating hydrocephalus with ventriculitis. She underwent many complicated neurosurgical interventions, and received long term broad-spectrum antimicrobials and dexamethasone. One month later, she had generalized seizures, and a large abscess was observed on scan (see images). A heavy growth of A. fumigatus was retrieved from the abscess, and amphotericin B and 5-flucytosine were started. Antifungal therapy was changed voriconazole due to intolerance to amphotericin B and worsening disorientation. Voriconazole dosing (which varied from 300mg to 100mg twice daily) was guided by plasma concentrations as enzyme induction with rifampicin and carbamazepine, and reduction in clearance with alcoholic liver disease complicated her voriconazole dosing. Steroids were gradually reduced. She had a good recovery and completed 9 months of voriconazole.

    Despite air filtration in the operating rooms, she apparently acquired an intra-operative infection, probably accelerated in presentation by concurrent dexamethasone. Rapid diagnosis and optimization of voriconazole dosing lead to a good outcome.

    image013, image75, image78, image80, image93, image195

  • Allergic Broncho-pulmonary aspergillosis. Pt CT. Extensive severe saccular bronchiectasis of the left lower lobe and to a lesser extent of the left upper and right lower lobe.

    Allergic Broncho-pulmonary aspergillosis. Pt CT. Extensive severe saccular bronchiectasis of the left lower lobe and to a lesser extent of the left upper and right lower lobe.

    image186

  • Pt CT severe ABPA

    Ct scan of chest. This patient with severe ABPA, serologically and radiologically, developed a spectrum of lesions in the lung. In this cut, a cavitating infiltrate in the anterior segment of the left upper lobe was visualised together with some bronchial thickening and bronchiectasis in the left upper and lower lobe.

    image185