Date: 26 November 2013
Image A. This 25 year old woman was previously well and presented with a pneumonia of uncertain aetiology. She has infiltrates in right upper-lobe and left middle and lower zones. The diagnosis was later made of chronic invasive pulmonary aspergillosis by bronchoscopy . Subsequently she was diagnosed with adult-onset chronic granulomatous disease with neutrophil function assays.
Image B. CT scan of the thorax just below the carina, showing almost complete opacification of the right lung and marked nodular shadowing around the hilum of the left lung.
Image C. Progression of pulmonary infiltrates are seen seven weeks later, despite administration of amphotericin B.
Image D. CT scan of the thorax above the carina showing near complete opacification of the right lung and multiple discrete nodular shadows in the left lung.
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Subacute IPA in rheumatoid nodules of the lung. in a patient with rheumatoid arthritis. Histology sections stained with H&E
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Subacute IPA in rheumatoid nodules of the lung. in a patient with rheumatoid arthritis. Histology sections stained with H&E.
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22/09/08 This chest radiograph shows bilateral hazy diffuse airspace disease predominating in the lower lungs with subtle nodularity in upper zones.
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Further details
Images 3a,b,c 02/07/07
CT thorax, after 2 weeks high dose erythromycin, showing a 2.8cm speculated lesion in the right upper lobe with a further 1.6cm similar mass on the left upper lobe also with a tendency for a central cavitation, and ill defined consolidation involving the peripheral aspect of both upper lobes and to a lesser extent right middle and both lower lobes.History:
A 71 year old woman presents with persistent dry cough. Her second CT scan of thorax shows lesions in the right and left upper lobes with ill defined consolidation in other areas (see images 3a, 3b and 3c). A PET scan is positive. She underwent right thoracotomy and sub-lobar wedge resection. Aspergillus grown from tissue and sputum grows Pseudomonas. Histology confirms the nodule to be non-small cell carcinoma (adenocarcinoma) but other lung areas show organizing pneumonia and another abscess formation with a cluster of branching septate hyphae. Despite starting itraconazole and oral ciprofloxacin she deteriorated with Type 1 respiratory failure. She was intubated and ventilated and switched to intravenous voriconazole and ceftazidime. She developed acute renal failure and then Enterococcus faecium bacteremia and she died 3 days later.
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