Aspergilloma on background pulmonary fibrosis

Case contributed by Dr Henry Knipe

Presentation

Chronic cough and shortness of breath.

Patient Data

Age: 60 years
Gender: Male

There is diffuse honeycombing seen with an apicobasal gradient, most severe in the right base associated with traction bronchiectasis. In the less affected apices, there is subpleural reticular opacity. Throughout both lungs, there is diffuse ground glass opacity, more prominent in the bases than apices.  Within the right base is a mobile 3.9cm oval opacity in a cystic space compatible with an aspergilloma.

Case Discussion

There are features of usual interstitial pneumonia (UIP) pattern throughout both lungs with severe cystic change in the right base with a superimposed aspergilloma. However, there is also diffuse ground glass opacity, which is not typical for UIP. The patient had a history on the referral of probable UIP and recent methotrexate pneumonitis and the combination of these likely explains the imaging findings. 

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Case information

rID: 60942
Published: 16th Jun 2018
Last edited: 14th Aug 2019
System: Chest
Inclusion in quiz mode: Included

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