Angioinvasive aspergillosis

Case contributed by A.Prof Frank Gaillard

Presentation

Young adult, neutropenic bone marrow transplant patient, with a fever.

Patient Data

Gender: Female

Chest x-ray

Modality: X-ray

Chest x-ray demonstrates a Hickman line in situ. In the left mid-zone a region of ill-defined opacity is noted, seen anterior to the oblique fissure on lateral projection, thus within the left upper lobe. The pleural spaces are clear. A radio-opaque metallic structure is external to the patient, not seen on lateral view. 

Modality: Annotated image

In the left mid-zone a region of ill-defined opacity is noted (blue dotted line), seen anterior to the oblique fissure (red dotted line) on lateral projection, thus within the left upper lobe. 

Chest x-ray - 4 days earlier

Modality: X-ray

Films obtained only four days earlier the lungs and pleural spaces are normal. This essentially excludes malignancy and any chronic process as the cause. 

CT chest

Modality: CT

CT chest confirms consolidation of anterior aspect of the left upper lobe, surrounded by a halo of ground glass opacity. No cavitation. 

Modality: Annotated image

Solid region of consolidation ( * ) surrounded by a halo of ground glass opacity (green dotted line).

The patient was treated with amphoteracin B, and clinically improved. Follow-up imaging was obtained. 

Chest x-ray - 10 days later

Modality: X-ray

Chest x-rays obtained 10 days later demonstrate significant reduction in the size of the left upper lobe opacity. 

Low dose spiral HRCT: 1 month after initial presentation

Modality: CT

CT scan three weeks later still (one month after presentation) demonstrates a residual but much smaller nodular region of opacification with only minimal ground glass opacity. 

Case Discussion

In a patient who is immunocompromised, there needs to be a low threshold for investigating for the possibility of angioinvasive aspergillosis, as without prompt treatment the infection can quickly overwhelm the patient. 

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Case Information

rID: 8651
Case created: 20th Feb 2010
Last edited: 24th Feb 2017
System: Chest
Inclusion in quiz mode: Included

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