Presentation
Shortness of breath.
Patient Data
There is a large cavity mass lesion seen right upper lung lobe abutting the mediastinum.
Slight thickening of the transverse interlobar fissure.
Rest of lung fields and costophrenic angles are clear.
Normal cardiothoracic ratio.
The cavitary lesion is still seen at the right upper zone with an air-fluid level in its dependant part.
Pulmonary consolidation involving the right middle and lower lung lobes, indicating lung collapse due to the ipsilateral mediastinal shift.
Hyperinflation of the left lung, without focal lesion and clear left costophrenic angle.
There are huge cavitary lesions seen in the right upper lung lobe measuring about eleven by ten centimeters with an irregular thick wall and a small air-fluid level at its most dependent part.
Surrounding pleural thickening is also seen.
Signs of volume loss of the right lung with midline shift to the right side.
Emphysematous lung changes are seen with a small air cyst, close to the right hilum.
Hyperinflated left lung with mild left apical fibrotic changes.
Partly calcified enlarged mediastinal lymph nodes are seen the largest in the pre-tracheal space measuring around seventeen millimeters.
Heterogeneous thyroid density is seen with calcification.
No evidence of pleural effusion.
Case Discussion
This is a 55-year-old lady presented initially with shortness of breath. A chest x-ray was requested demonstrated a cavitary lesion at the apex of the right lung. Previous CT guided true cut needle biopsy from the solid component of this lesion done upon initial presentation proved that it is a non-malignant lesion. Two years later presented with fever and cough when sputum sample for cytology was requested showed the following.
Sputum Cytology Report:
Few aggregates of neutrophils were seen, associated with branching septate fungal hyphae, confirmed by silver stain. Their morphology is consistent with Aspergillus species. Negative for malignant cells.
Diagnosis of invasive aspergillosis was made and the patient has been managed accordingly.
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