Images in Clinical Medicine
Aspergilloma
N Engl J Med 2002; 346:256January 24, 2002
- Article
Figure 1 A 45-year-old man was admitted for relapse of acute promyelocytic leukemia nine months after the first remission. Severe neutropenia had developed after salvage chemotherapy with mitoxantrone, cytarabine, and all-trans -retinoic acid and was complicated by invasive pulmonary aspergillosis. The patient initially received antifungal treatment with amphotericin B, followed by five months of treatment with itraconazole after his blood count had returned to normal. The patient was afebrile and had no clinical signs of pulmonary disease; his only symptom was a cough that produced yellowish-brown sputum in which Aspergillus fumigatus mycelia was persistently present. A chest x-ray film (Panel A) revealed an air-crescent sign around the sequestrum, and computed tomography showed that the lesion had invaded the right main bronchus, resulting in the formation of a fistula (white arrow in Panel B). The lesion was also close to the right pulmonary artery (black arrow in Panel B), and there was tissue inflammation outside the posterior wall of the cyst that extended through the pulmonary parenchyma (open arrow in Panel B). The patient underwent a right superior pulmonary lobectomy as soon as his clinical situation permitted. Histologic examination of the resected right upper pulmonary lobe showed a typical fungus ball measuring 4 by 4 by 3.5 cm that was surrounded by a pink exudative material that contained many necrotic aspergillus mycelia. The sequestrum communicated with the right main bronchus by means of a fistula. At the time of the last follow-up visit nine months after thoracic surgery, the patient had no pulmonary symptoms, and his acute leukemia was still in second remission.
Ayhan Ulusakarya, M.D.
Institut Gustave-Roussy, 94805 Villejuif, France- Citing Articles (1)
Citing Articles
1
Elizabeth Cerceo, Robert M. Kotloff, Denis Hadjiliadis, Vivek N. Ahya, Alberto Pochettino, Colin Gillespie, Jason D. Christie. (2009) Central Airways Obstruction Due to Aspergillus fumigatus After Lung Transplantation. The Journal of Heart and Lung Transplantation 28:5, 515-519
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