Presentation
Persistent cough post chemotherapy. Past history diffuse large B-cell lymphoma.
Patient Data
Initial CXR
Almost complete collapse of the right upper lobe.
Right upper lobe collapse with mucus plugging in the right upper lobe bronchus and its branches. There is no evidence of invasion into the pulmonary vessels. The previously demonstrated right lower lobe nodule is more pronounced with adjacent atelectasis and patchy ground glass opacity. Further non-obstructive mucus plugging is seen within the left upper lobe bronchus. There is left basal band atelectasis.
Patient went on to have a bronchoscopy. Results of bronchoscopy shown below:
Histology and additional laboratory studies
RUL sputum plug: Plug right upper lobe of lung: Mucous plug with eosinophilia and fungal hyphae, raising the possibility of asthma/allergic bronchopulmonary aspergillosis
Bronchial washings: Eosinophilia with fungal elements identified
Fungal Culture: Aspergillus fumigatus ISOLATED
Post bronchoscopy CXR
The previously noted collapse and consolidation of the right upper lobe has considerably improved. Significant lung volume loss persists; however, there is now good aeration of segments of the apical anterior and posterior segments of the right upper lobe.
Case Discussion
Typical appearance of RUL collapse.
Aspergillus is a common organism and does not necessarily imply pathology. In this case, the possibility of ABPA was raised; however, in the absence of bronchiectasis or a history of asthma-like symptoms, this is unlikely.
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