Date: 21 January 2014
Further details
Image B. Additional cavities are apparent inferior to this large cavity and are in communication both with the bronchi and the additional cavities. Some of the apparent cavities are probably dilated bronchi. The left lower lung is completely opacified otherwise. The degree of pleural fibrosis surrounding the left apical cavity is reduced slightly over the interval of four months.
Image C. This shows an almost normal hyperexpanded right lung with a very substantially contracted left lung with one large airway visible and probably incontinuity with a slightly irregular cavity containing some debris, presumably fungal tissue. Other levels show very large left apical cavity with numerous subsections containing debris or fibrotic tissue and almost complete fibrosis of the lung below the level of the carina on the left, with some calcification within the fibrotic lung tissue.
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PtDS2 –Repeated chest infections arrested by itraconazole therapy in ABPA and bronchiectasis
DS2 developed asthma age 24 and now aged 62. From about age 30 she started getting repeated chest infections and a few years later ABPA and bronchiectasis was diagnosed. Infections continued requiring multiple courses of antibiotics annually. At one point DS2 developed a pneumothorax, possibly because of excess coughing. She has chronic rhinitis and mannose binding lectin deficiency. In May 2011, she started itraconazole therapy, and has needed no antibiotic courses for her chest since. Her rhinitis with sinusitis occasionally bothers her. She is delighted to have gone 18 months with no chest infections.
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Aspergillus hyphae (arrow) in the lumen without invasion of the necrotic bronchial wall (*) (Nicod 2001).
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fibrinonecrotic material (arrow) from the airway shown in A, with subocclusion of the bronchial lumen (*)
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Fibrinous or pseudomembranous bronchitis (arrow) with subocclusion of the airways (* indicates subocclusion of the airways by pseudomembranes)
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Bronchoscopic biopsy demonstrated septate hyphae with branching at 45o (methenamine silver stain ×400).
