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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Image A
CT Scan 30/3/99
Showing extreme pleural thickening and 2 small cavities at apex of left lung.
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A 43 year old with smoking related emphysema was admitted to hospital with two separate episodes of haemoptysis. He had been in good health up to 1989, when he was diagnosed as having bilateral pulmonary tuberculosis. At that time a CT scan revealed a cavity in the left upper lobe (20.8cm2) with adjacent confluent infiltrates and pleural thickening. On bronchoscopic examination no abnormalities were noted and endobronchial biopsies did not reveal hyphae.
Over the next 4 years his condition deteriorated and a CT scan showed the left upper lobe cavity had increased to 40cm2. Itraconazole 400mg daily was prescribed. There was some clinical improvement on itraconazole but patient eventually deteriorated with breathlessness and with significant weight loss.
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