Pt DT – Aspergilloma/chronic IPA

Date: 26 November 2013

This chest radiograph (AMBER film) demonstrates the typical extensive pleural thickening at the right apex, seen in patients with aspergillomas. The cavity appears not to contain an aspergilloma but on CT scan had some ‘debris’ and Aspergillus antibiotics (precipitins) were strongly positive. The differential diagnosis lies between an aspergilloma and chronic invasive pulmonary aspergillosis. The extensive pleural thickening is heavily in favour of an aspergilloma, even without a well demonstrated fungal ball in the cavity.

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  • fibrinonecrotic material (arrow) from the airway shown in A, with subocclusion of the bronchial lumen (*)

    fibrinonecrotic material (arrow) from the airway shown in A, with subocclusion of the bronchial lumen (*);

  • Fibrinous or pseudomembranous bronchitis (arrow) with subocclusion of the airways (* indicates subocclusion of the airways by pseudomembranes)

    Fibrinous or pseudomembranous bronchitis (arrow) with subocclusion of the airways (* indicates subocclusion of the airways by pseudomembranes);

  • Bronchoscopic biopsy demonstrated septate hyphae with branching at 45o (methenamine silver stain ×400).

    Bronchoscopic biopsy demonstrated septate hyphae with branching at 45o (methenamine silver stain ×400).

  • Bronchoscopic manifestations of Aspergillus tracheobronchitis. (a) Type I. Inflammatory infiltration, mucosa hyperaemia and plaques of pseudomembrane formation in the lumen without obvious airway occlusion. (b) Type II. Deep ulceration of the bronchial wall. (c) Type III. Significant airway occlusion by thick mucous plugs full of Aspergillus without definite deeper tissue invasion. (d) Type IV. Extensive tissue necrosis and pseudomembrane formation in the lumen with airway structures and severe airway occlusion (Wu 2010).

    Bronchoscopic manifestations of <em>Aspergillus</em> tracheobronchitis. (a) Type I. Inflammatory infiltration, mucosa hyperaemia and plaques of pseudomembrane formation in the lumen without obvious airway occlusion. (b) Type II. Deep ulceration of the bronchial wall. (c) Type III. Significant airway occlusion by thick mucous plugs full of <em>Aspergillus</em> without definite deeper tissue invasion. (d) Type IV. Extensive tissue necrosis and pseudomembrane formation in the lumen with airway structures and severe airway occlusion (Wu 2009).

  • High resolution CT showing centrilobular nodular opacities and branching linear opacities (tree-in-bud appearance) (Al-Alawi 2007).

    Figure 6: High resolution CT showing centrilobular nodular opacities and branching linear opacities (tree-in-bud appearance) (Al-Alawi 2007).

  • Chest X-ray showing poorly defined bilateral nodular opacities (Al-Alawi 2007).

    Chest X-ray showing poorly defined bilateral nodular opacities (Al-Alawi 2007).

  • Mucus plugs seen obstructing the lumen of the bronchi (Kramer 2005).

    Obstructing tracheobronchitis. Mucus plugs seen obstructing the lumen of the bronchi (Kramer 2005).

  • Gross pathologic specimen from autopsy shows the bronchial lumen covered by multiple whitish endobronchial nodules (arrows) (Franquet 2002).

    Gross pathologic specimen from autopsy shows the bronchial lumen covered by multiple whitish endobronchial nodules (arrows) (Franquet 2002).

  • Invasive tracheobronchitis showing numerous nodules seen during bronchoscopy (Ronan D’Driscoll).

    Invasive tracheobronchitis showing numerous nodules seen during bronchoscopy (Ronan D’Driscoll).

  • Pseudomembranous seen overlying the bronchial mucosa (Tasci 2006).

    Pseudomembranous seen overlying the bronchial mucosa (Tasci 2006).


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