Date: 26 November 2013
Further details
June 2009 – CT scan of the chest (two images D & E). These scans show residual large bullae, particularly notable in the apex of the left lung on both cuts. Small residual bullae remain in the right apex following a bullectomy which greatly reduced the size and number of these lesions.
Pt RK Lung bullae caused by cannabis smoking complicated by pneumothorax and chronic cavitary pulmonary aspergillosis.
February 2009 – Chest x-ray showing bilateral apical bullae most marked on the right in association with a right pneumothorax. A chest drain is in-situ.
Late February 2009 – persistent apical bullae right upper zone with resolving pneumothorax. Chest drain still in-situ. Increasing right upper lobe shadowing possibly representing infection or haemorrhage.
April 2009 – Post-operative chest x-ray showing post apical bullectomy on the right, resolved pneumothorax but the interval development of fluid in the right costo-phrenic angle with air fluid levels consistent with recent surgery. Great reduction in apical bullae in the right apex but increasing consolidation proximally in the right upper zone and some fluid in the horizontal fissure. These findings are following an apical bullectomy and pleurodesis of his prior significant pneumothorax.
June 2009 – CT scan of the chest (two images – see above). These scans show residual large bullae, particularly notable in the apex of the left lung on both cuts. Small residual bullae remain in the right apex following a bullectomy which greatly reduced the size and number of these lesions.
This patient underwent a bullectomy to remove part of the lung after developing lung bullae associated with cannabis smoking. The transverse section (G) of the specimen clearly shows the bullae along the left side and lower edge of the section. I and J demonstrate the dark pigment seen in accumulated macrophages. Tobacco smoking alone also causes a dark pigment, but evidence suggests that in marijuana smokers this pigment accumulates much faster and even with reduced exposure. The manner in which marijuana is smoked ie. without a filter and extended holding of the breath may contribute to this observation.
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Notes: n/a
Images library
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Light microscopic image of hyphae in an aspergilloma (10x magnification)
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Light microscopic image of hyphae in an aspergilloma (400x magnification)
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An aspergilloma (or fungal ball) is a mass of fungus found inside the body, for example inside cavities such as the lungs or sinuses, or as abscesses in organs such as the brain or kidney. They are made up of threadlike fungal strands (hyphae) that are densely packed but only around 1/200 of a millimetre in diameter. A mass of hyphae is called a mycelium.
In this image, a slice through an aspergilloma has been imaged using a transmission electron microscope.
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Aspergillus can punch through the lining of the lungs and invade the blood vessels below, in a process called angioinvasion. It can result in blockage (occlusion) of the blood vessel and damage to the local tissue through lack of oxygen (infarction). In severely immunocompromised patients, fragments can even break off and travel to other organs in the body.
In this image, a tissue section through a blocked blood vessel has been stained with the dyes haematoxylin (purple, binds DNA) and eosin (pink, binds proteins).
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Showing the edge of a colony of aspergillus forming a fungal ball. The fungal hyphae exhibit dichotomous 45 degree angle branching and septae typical of Aspergillus.
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Pt CJ finger clubbing, this patient had chronic cavitary pulmonary aspergillosis, with an aspergilloma since 1988, following an episode of haemoptysis. Currently patient still has symptomatic disease.
Images E,F Blood stained sputum samples from this patient.
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Disseminated, invasive aspergillosis showing dichotomously branching hyphae. Original magnification x300. Stained with Gomori Methenamine Silver (GMS).
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Disseminated, invasive aspergillosis showing dichotomously branching hyphae. Original magnification x150. Stained with Gomori Methenamine Silver (GMS).
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Disseminated, invasive aspergillosis showing dichotomously branching hyphae. Original magnification x50. Stained with Gomori Methenamine Silver (GMS).
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Light microscopical appearance of invasive pulmonary aspergillosis showing vessel occlusion with thrombus and distal infarction (Haematoxylin and eosin, x100)
