A 48-year-old male patient with history of long exposure to dusts (especially plaster) and previous pulmonary tuberculosis (TB) presented with dyspnea on exertion, cough and hemorrhagic sputum. Smoking habit was not reported.
Physical examination revealed decreased intensity of vesicular breathing in right side and diffuse crackles at pulmonary auscultation.

Chest radio-graph and high resolution CT (HRCT) of the chest were performed.Identify the abnormality?

ANSWER

Chest radiograph demonstrated two cavitary lesions presenting with the "air-crescent sign" in medial and upper zones of the lungs, bilaterally.
In high resolution CT (HRCT) of the chest, diffuse fibrotic changes with areas of disruption of normal lung anatomy were present, associated with cavitations, most likely secondary to the previous TB infection. More specifically there were two thick-walled lung cavities containing radiodense "material". One of them presented with the classic "sponge like" appearance.he findings were consistent with the presence of fungus balls within the preexisted cavities.

Answer - Bilateral aspergillomas



Aspergilloma (also known as mycetoma or fungus ball) is a collection of hyphae of fungus, almost with the morphology of a ball, also accumulating cellular debris, which usually colonizes already existing cavities, generally as a result of previous pulmonary diseases, such as sarcoidosis or pulmonary tuberculosis.This colonization usually begins as a nodular thickening of the cavity, formed by the conglomeration of hyphae. When not supportable within the inner wall, the fungus ball falls in the cavity, mixing with cellular debris and having a “sponge like” appearance due to presence of air pockets within the lesion. As there is no attachment to the wall of the cavity, the aspergilloma changes its position with the mobility of the patient.
Aspergillomas are more common in middle-aged patients, being asymptomatic and discovered accidentally. However, sometimes aspergillomas can be found following an episode of haemoptysis, which is a relatively frequent presentation.
The other types of Aspergillus infection allergic bronchopulmonary aspergillosis, semi-invasive aspergillosis, airway-invasive aspergillosis and angioinvasive aspergillosis .
A minority of aspergillomas can resolve spontaneously.In cases of severe haemoptysis surgical resection is indicated.

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14 comments

  1. Bronchiectasis. If the patient has pulmonar TB antecedent, it is a probable diagnostic, due that it's a common complication amongst the lung types of TB

     
  2. Dr Chhabra Says:
  3. Bilateral Post-tubercular fibrocavitary disease with aspergilloma

     
  4. Rida Iqbal Says:
  5. pneumoconiosis.. silicosis perhaps..

     
  6. kamran ali Says:
  7. active tuberculosis with fibrosis

     
  8. Anonymous Says:
  9. Lung :Tracheal deviation right side, Fibrosis, Infiltrat, Athelectasis, and Bronchiectasis. I think Destroyed Lung cause Late Pulmonary Tuberculosis- far Advances.

     
  10. Anonymous Says:
  11. late stage of pul tb with cavity formation

     
  12. Anonymous Says:
  13. Active TB represented by cavitory lesion in upper zone on Right side,shifting of trachea to right side with volume loss and tenting of diaghpragm on right side and a nonhomogenous opacity sorrounded by a rim of lucency, "crescent sign" suggestive of ASPERGILLOMA on Right side , all are due to complication of pulmonary TB.
    On left side, a non homogenous opacity in the upper zone with CT findings are likely suggestive of a mass lesion probably "Scar carcinoma" due to old TB lesions

     
  14. Anonymous Says:
  15. aspergilloma

     
  16. mike Says:
  17. bpc with metastasis and the deviation of the traheea

     
  18. Anonymous Says:
  19. Aspergilloma.

     
  20. Anonymous Says:
  21. Aspergilloma
    Ddx. Pulmonary TB with cavitary lesion

     
  22. Anonymous Says:
  23. fibrosis pulmonar por TB

     
  24. Dr.Anum Says:
  25. the hx of case should be m0re c0mprehensive and suggestive of diagn0sis and less emphasis should be made on investigati0n findings.it was a gud case but there could be many differential diagnosis that should be ruled out like reactivati0n of pulm0nary tb,lung ca etc.

     
  26. Dr.ahmed Says:
  27. silicosis has the association with tb

     

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