Pt MB Chronic Pulmonary Necrotising Aspergillosis with TB

Date: 21 January 2014

  • Image A. This plain chest x-ray showed two large cavities, one smaller cavity in the completely opacified left hemithorax, which contains fibrotic tissue.

  • Image B. Significant progression of the two cavities at the left apex, which have merged into one is apparent.

  • Image C CT scan of thorax with a section at the carina.

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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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  • Patient CD: Voriconazole rash in ABPA patient.

    Facial erythema: Voriconazole rash in ABPA patient resistant to corticosteroids, treated with voriconazole 200mg BID. Serum voriconazole levels were very low and the dose was raised to 250mg BID. Within 3 weeks patient had developed remarkable facial erythema. His trough voriconazole concentration at this time was 370ng/ml. When voriconazole was stopped because of the facial erythema and lack of impact on his ABPA his facial erythema resolved over 4 weeks.

    Forearm erythema related to voriconazole. As with facial erythema patient developed remarkable forearm erythema with lesions similar to porphyria cutanea tarda all of which resolved with stopping voriconazole.

    Facial erythema related to voriconazole, Forearm erythema related to voriconazole 1, Forearm erythema related to voriconazole 2

  • Patient with allergic fungal sinusitis – staining of eosinophilic mucin

    Eosinophilic mucin containing numerous eosinophils and Charcot-Leyden crystals (arrow). Stain PAS x400. Patient with allergic fungal sinusitis

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  • Fungal ball removed from sinus (Pt SK)

    A whole fungal ball removed from the sinus by endoscopic surgery. No staining x 10

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  • Fungal ball removed from sinus (Pt SK)

    Crushed fungal material removed from sinus by endoscope. No staining x40

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  • Chronic invasive sinus aspergillosis Pt DA 68yr male.

    This 68 year man with a history of hypertension and ischemic heart disease presented with nasal obstruction, localised swelling and pain in his right cheek for about two months. CT scan showed a soft tissue mass filling the right maxillary sinus adjacent to the floor of the orbit. Maxillotomy with mass removal was performed and culture grew A. fumigatus. Histology was not performed and the patient received no antifungal therapy. 5 months later localised relapse with progression along the medial wall of the orbit was seen on CT scan.

    Image A. MRI (T2-weighted, transversal view).Note oedema of the right temporal lobe., Image B MRI (T1-weighted, transversal view). The blue pointer shows progression of inflammatory tissue into the brain. The green pointer shows involvement of the lateral group of external ocular muscles., Image C CT scan image (bone window, coronal view) demonstrating destruction of the inferior wall of the right orbit., Image D. MRI (T1-weighted, contrast-enhanced, transversal view). The pointers show abnormal enhancement in the right orbit (green), in the right temporal lobe (blue) and of the dura (yellow). , Image E MRI (T1-weighted, contrast-enhanced, coronal view). The pointers show pathological tissue in the right cavernous sinus (blue) and pathological enhancement of the right optical nerve (green)., Image F MRI (T1-weighted, contrast-enhanced, sagittal view). The pointers show pathological tissue in the right orbit (blue) with protrusion into the right optical canal (green).

  • Yamik catheter for rinsing nasal and paranasal cavities

    Yamik catheter for rinsing nasal and paranasal cavities. Image D

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  • Yamik catheter for rinsing nasal and paranasal cavities

    Yamik catheter for rinsing nasal and paranasal cavities. Image C

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