1
|
Gordeeva OM, Egorova AD, Chesalina YO, Gretcov EM, Semenova LA, Karpina NL, Sivokozov IV. [Difficult case of differential diagnosis of partial lung atelectasis. Case report]. TERAPEVT ARKH 2023; 95:248-254. [PMID: 37167147 DOI: 10.26442/00403660.2023.03.202074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
In December 2018 the patient over 60 years old sought medical help with complaints of persistent cough. Based on computed tomography data there were identified the sings (symptoms) of right lung lower lobe atelectasis. To run this patient diagnostics there were performed 6 bronchoscopies narrowed down by bronchi checks up only and described the right lung central cancer picture. At the same time the biopsy taken during one of the bronchoscopies appeared non informative. Fine needle biopsy of mediastinal lymph nodes and bronchial wall was performed twice: at Tomsk Cancer Research Institute (it was suspected B-cell lymphoma based on biopsy examination) and at The Loginov Moscow Clinical Scientific Center (signs of inflammation based on biopsy examination). The video-assisted thoracoscopy with lymph node dissection of the right lung root was performed in January 2020. As a surgical material analysis result reactive adenopathy was determined. Therefore, during more than 1 year of diagnostic research the genesis of right lung lower lobe atelectasis was not established. The patient was directed to Central Tuberculosis Research Institute for diagnosis verification. Based on clinical and radiological picture Central Tuberculosis Research Institute colleagues suspected a foreign body in the intermediate bronchus. During an endoscopic examination it was revealed stenosis, biopsies were performed, but the foreign body could not be identified. In the pathomorphological laboratory of Central Tuberculosis Research Institute there were conducted histological examination of the material after endobronchial cryobiopsy and rigid needle biopsy. Both gave an unexpected result: invasive mycosis of the bronchial wall. As a conclusion the decision was taken to apply antimycotic therapy on an outpatient basis. As a result, clear clinical and radiological positive dynamics was obtained. In these favorable conditions for endoscopic examination, it was performed vitally essential cryoextraction of foreign body. The foreign body turned out to be a fragment of a spongy bone of a centimeter size. These actions have let to unlock the right lung lower lobe.
Collapse
|
2
|
Muacevic A, Adler JR, Agarwal R. An Unusual Pulmonary Aspergillus Infection: Endobronchial Aspergilloma. Cureus 2023; 15:e33587. [PMID: 36788918 PMCID: PMC9910822 DOI: 10.7759/cureus.33587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/11/2023] Open
Abstract
Endobronchial aspergilloma (EBA) is an extremely rare presentation of pulmonary involvement of Aspergillus. It is a noninvasive form of pulmonary aspergillosis where the fungus overgrows and colonizes the bronchial lumen. The patient may present with chronic cough, dyspnea, hemoptysis, or wheezing. The diagnosis is usually incidental when bronchoscopy is performed to evaluate the cause of hemoptysis or radiological abnormalities. Here, we report a case of a middle-aged female who presented with hemoptysis and right middle lobe collapse and was subsequently diagnosed to have EBA on bronchoscopy with endobronchial biopsy. Although EBA is rare, it should be considered as a differential in the evaluation of endobronchial mass lesions.
Collapse
|
3
|
Durliat A, Locatelli-Sanchez M, Wallet F, Allaouchiche B. Tracheal stent aspergillosis occurring after aortic allograft of the trachea. Transpl Infect Dis 2022; 24:e13965. [PMID: 36349860 DOI: 10.1111/tid.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/03/2022] [Accepted: 07/22/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Aspergillosis is a fungal infection with many clinical forms. Invasive aspergillosis is the most widely known severe manifestation, but other forms can need intensive care. AIM Our purpose is to report a case of tracheal aspergilloma and provide a review of the literature concerning endobronchial aspergillus. METHOD We report a case of tracheal aspergilloma causing tracheal obstruction in a patient admitted in the ICU for respiratory distress. The aspergilloma occurred in a tracheal stent implanted during tracheal allograft for tracheal cancer. A combination of local and systemic antifungal was used with successful result.
Collapse
Affiliation(s)
- Alix Durliat
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Réanimation, Pierre-Bénite, France
| | | | - Florent Wallet
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Réanimation, Pierre-Bénite, France
| | - Bernard Allaouchiche
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Réanimation, Pierre-Bénite, France.,Université Claude Bernard, Lyon, France.,VetAgro Sup, Université de Lyon, Marcy l'Étoile, France
| |
Collapse
|
4
|
Sharma D, Khanduri R, Raghuvanshi S, Chandra S, Khanduri S, Jethani V, Kumar M. Clinical, radiological and histopathological profile of patients with endobronchial lesions on fibreoptic bronchoscopy. Monaldi Arch Chest Dis 2022. [DOI: 10.4081/monaldi.2022.2312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Various pulmonary diseases, both benign as well as malignant, manifest in the form of endobronchial lesions on bronchoscopy. Malignancy is frequently the provisional diagnosis in the mind of a chest physician undergoing an endobronchial biopsy. Other benign diseases, however, may present similarly on bronchoscopy and computerized tomography (CT) scan. This observational study was conducted to better understand why there is such a wide range of endobronchial lesions with even more diverse radiological and pathological presentations. The research was carried out at the Department of Respiratory Medicine, Himalayan Institute of Medical Science (HIMS), Swami Ram Nagar, Dehradun. Subjects were recruited from HIMS, Dehradun patients over a 12-month period (August 2020 to July 2021). The study included patients (over the age of 18) who had a fibreoptic bronchoscopy and were found to have an endobronchial lesion. After a thorough history, examination, and application of the inclusion and exclusion criteria. 120 patients were enrolled. The majority of patients were between the ages of 56 and 65, with males outnumbering females. The majority of the patients were smokers, and the most common complaint was shortness of breath. Poorly differentiated carcinoma and squamous cell carcinoma were the most common endobronchial lesions in men, while small cell carcinoma was the most common in women. A mass lesion was the most common radiological finding, followed by mediastinal lymphadenopathy, and an exophytic lesion was the most common endobronchial lesion detected in bronchoscopy. We looked at the diseases that cause endobronchial lesions and their clinico-radiological and histopathological profiles. This study clearly demonstrates the importance of studying the histopathological profiles of patients with endobronchial growth, which can mimic malignancy in rare cases.
Collapse
|
5
|
Komatsu M, Yasuo M, Wada Y, Takata M, Azuhata H, Ikuyama Y, Akahane J, Sonehara K, Ushiki A, Yamamoto H, Hanaoka M. Obstructive Pneumonia Associated with Endobronchial Aspergilloma: Successful Treatment with Interventional Bronchoscopy and Antifungals. Intern Med 2022; 61:2643-2647. [PMID: 35135911 PMCID: PMC9492488 DOI: 10.2169/internalmedicine.8202-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Endobronchial aspergilloma is a rare disease. A 64-year-old man with severe diabetes mellitus developed a cough and fever and was referred to our hospital. He was diagnosed with obstructive pneumonia associated with endobronchial aspergilloma, underwent interventional bronchoscopy, and was treated with antifungals. While the optimal treatment has not been established, interventional bronchoscopy along with systemic antifungals may improve the outcome in such cases.
Collapse
Affiliation(s)
- Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Masanori Yasuo
- Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Japan
| | - Yosuke Wada
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | | | | | - Yuichi Ikuyama
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Jumpei Akahane
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Kei Sonehara
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Atsuhito Ushiki
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| |
Collapse
|
6
|
Izhakian S, Kramer M. Endobronchial aspergilloma: Benign appearance of potentially fatal consequences. INDIAN J PATHOL MICR 2022; 65:944-945. [DOI: 10.4103/ijpm.ijpm_116_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
7
|
Silvestre CR, Cavaco M, Nunes A, Cordeiro RJ, Torres C, Ribeiro A, André N, Falcão T, Félix F, Domingos AC. Beyond the skin – A rare case of primary pulmonary melanoma and endobronchial aspergilloma. Respir Med Case Rep 2022; 36:101605. [PMID: 35242518 PMCID: PMC8866094 DOI: 10.1016/j.rmcr.2022.101605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/26/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Melanoma is an aggressive skin tumor, but it may be present in other locations. Primary lung melanoma and endobronchial aspergilloma are rare entities. The authors report a case of a 72-year-old, asthmatic woman, with worsening of her respiratory complaints. Imaging revealed finger in glove sign at the left hemithorax. Bronchoscopy revealed an elongated mass with evidence of Aspergillus. Despite endoscopic mass removal, the patient maintained the nodular imaging at the left hemithorax. She underwent thoracic surgery, and the histological evaluation identified malignant melanoma. After undergoing a thorough evaluation, we excluded other melanocytic lesions, and assumed the diagnosis of primary malignant lung melanoma. This case demonstrates a rare association between endobronchial aspergilloma and primary lung melanoma, raising awareness of considering the co-existence of lung tumor in the presence of endobronchial aspergilloma, and showing endobronchial aspergilloma mimicking malignant lesions. Malignant melanoma can appear in locations other than skin. Lung involvement of malignant melanoma is associated in most cases with metastases. Endobronchial aspergilloma is a form of aspergillosis. Endobronchial aspergilloma may mimic or occult lung cancer.
Collapse
Affiliation(s)
- Carina Rôlo Silvestre
- Pulmonology Department – Centro Hospitalar do Oeste, Rua Dr. Aurélio Ricardo Belo, 2560-364, Torres Vedras, Portugal
- Corresponding author. .
| | - Maria Cavaco
- Pulmonology Department – Centro Hospitalar do Oeste, Rua Dr. Aurélio Ricardo Belo, 2560-364, Torres Vedras, Portugal
| | - André Nunes
- Pulmonology Department – Centro Hospitalar do Oeste, Rua Dr. Aurélio Ricardo Belo, 2560-364, Torres Vedras, Portugal
| | - Ricardo José Cordeiro
- Pulmonology Department – Centro Hospitalar do Oeste, Rua Dr. Aurélio Ricardo Belo, 2560-364, Torres Vedras, Portugal
| | - Carolina Torres
- Thoracic Surgery Department – Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Alameda das Linhas de Torres 117, 1769-001, Lisboa, Portugal
| | - Analisa Ribeiro
- Pathology Department – Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Alameda das Linhas de Torres 117, 1769-001, Lisboa, Portugal
| | - Natália André
- Pulmonology Department – Centro Hospitalar do Oeste, Rua Dr. Aurélio Ricardo Belo, 2560-364, Torres Vedras, Portugal
| | - Teresa Falcão
- Pulmonology Department – Centro Hospitalar do Oeste, Rua Dr. Aurélio Ricardo Belo, 2560-364, Torres Vedras, Portugal
| | - Francisco Félix
- Thoracic Surgery Department – Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Alameda das Linhas de Torres 117, 1769-001, Lisboa, Portugal
| | - António Carlos Domingos
- Pulmonology Department – Centro Hospitalar do Oeste, Rua Dr. Aurélio Ricardo Belo, 2560-364, Torres Vedras, Portugal
| |
Collapse
|
8
|
El Hage H, Fagel L. A Case of Endobronchial Aspergilloma Coexisting With Lung Adenocarcinoma. Cureus 2020; 12:e11736. [PMID: 33403168 PMCID: PMC7773290 DOI: 10.7759/cureus.11736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aspergillus species can cause a variety of lung diseases. Endobronchial aspergilloma is a rare clinical entity rarely encountered and often not included in the classification of Aspergillus lung diseases. An 82-year-old woman presented to the outpatient setting with wheezing, shortness of breath, and productive cough. CT of the chest showed the presence of airway enlargement in a finger in glove pattern in the right upper lobe suggestive of allergic bronchopulmonary aspergillosis. Despite adequate treatment the abnormality persisted on repeat imaging. Bronchoscopy with biopsies eventually revealed the presence of hyphal elements suggestive of Aspergillus and poorly differentiated adenocarcinoma. Endobronchial aspergilloma is rare and not included in the classification of Aspergillus lung diseases. It is thought to result from airway colonization by Aspergillus species. Occasionally it can obscure an underlying lung carcinoma and thus delay the diagnosis. Diagnosis is made by pathological examination of biopsy specimens. Optimal treatment is not well established.
Collapse
Affiliation(s)
- Halim El Hage
- Pulmonary and Critical Care Medicine, Holy Redeemer Hospital and Medical Center, Meadowbrook, USA
| | - Leon Fagel
- Pathology, Holy Redeemer Hospital and Medical Center, Meadowbrook, USA
| |
Collapse
|
9
|
Postoperative Bleeding from the Pulmonary Artery Stump Due to Inflammatory Erosion Caused by Aspergillus Infection: First Case of the Literature. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02179-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
10
|
YOSHIZAKI ASUKA, YAMAMOTO MASATSUGU, HIRABAYASHI AYA, ONO YOSHIHIKO, HATAKEYAMA YUKIHISA, NAKATA KYOSUKE, TAMURA DAISUKE, TACHIHARA MOTOKO, KAMIRYO HIROSHI, KOBAYASHI KAZUYUKI, NISHIO MARI, NISHIMURA YOSHIHIRO. Fatal Hemoptysis Due to Endobronchial Aspergilloma in the Hyperinflated Native Lung after Single-Lung Transplantation for Lymphangioleiomyomatosis: A Case Report. THE KOBE JOURNAL OF MEDICAL SCIENCES 2020; 65:E114-E117. [PMID: 32201425 PMCID: PMC7447097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/03/2019] [Indexed: 06/10/2023]
Abstract
Pulmonary lymphangioleiomyomatosis accounts for the majority of cadaveric lung transplantation cases. Post-transplantation management is continuingly necessary not only to prevent the progression of LAM but also to address complications. A woman with lymphangioleiomyomatosis underwent cadaveric lung transplantation. She developed post-operative native lung hyperinflation and hemoptysis with cavity shadow in the native lung on computed tomography. Isolated Aspergillus from her sputum and positive Aspergillus galactomannan antigen in the blood led to a diagnosis of aspergillosis. Despite the reduction of hemoptysis by antifungal medication, she developed fatal hemoptysis. An autopsy showed an Aspergillus fungal mass in the bronchus in the native lung whilst the lung graft was free from lymphangioleiomyomatosis lesions. Endobronchial aspergilloma was suggested to be a cause of hemoptysis. This fatal clinical course suggested that hemoptysis due to endobronchial aspergilloma in the native lung should have been considered native lung pneumonectomy as a further intervention.
Collapse
Affiliation(s)
- ASUKA YOSHIZAKI
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - MASATSUGU YAMAMOTO
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - AYA HIRABAYASHI
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - YOSHIHIKO ONO
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - YUKIHISA HATAKEYAMA
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - KYOSUKE NAKATA
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - MOTOKO TACHIHARA
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - HIROSHI KAMIRYO
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - KAZUYUKI KOBAYASHI
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - MARI NISHIO
- Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - YOSHIHIRO NISHIMURA
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
11
|
Ngu S, Narula N, Abureesh M, Li JJ, Chalhoub M. Endobronchial aspergilloma-a comprehensive literature review with focus on diagnosis and treatment modalities. Eur J Clin Microbiol Infect Dis 2019; 39:601-605. [PMID: 31741102 DOI: 10.1007/s10096-019-03726-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/26/2019] [Indexed: 11/28/2022]
Abstract
Endobronchial aspergilloma (EBA) is a rare manifestation of pulmonary infection with Aspergillus spp. Comprised of hyphae, mucus, and cellular debris, the massive fungus overgrowth can lead to obstructive pneumonitis in large airways, manifesting as cough, dyspnea, hemoptysis, or weight loss. The aim of this paper is to review the literature on endobronchial aspergilloma to further elucidate this disease entity and to classify it as a non-invasive form of pulmonary aspergillosis. A descriptive analysis was performed on articles on PubMed database that contained the key word "endobronchial aspergilloma." A total of 28 cases were obtained. Four articles were excluded as they were not available in the English format. Although EBA is extremely rare, it should be considered in the differential diagnosis of endobronchial masses in immunocompromised patients. There is a potential for the disease entity to progress to tracheobronchitis and fulminant respiratory failure. As such, early detection with bronchoscopy, biopsy, and culture is required to confirm pulmonary aspergillosis. Current treatment regimens remain to be optimized, though piecemeal resection of the mycetoma with bronchoscopic techniques with the addition of systemic antifungals and their combinations has been reported as efficacious.
Collapse
Affiliation(s)
- Sam Ngu
- Staten Island University Hospital, 70 Hancock Street, Unit 1C, Staten Island, NY, 10305, USA.
| | - Naureen Narula
- Staten Island University Hospital, 70 Hancock Street, Unit 1C, Staten Island, NY, 10305, USA
| | - Mohammad Abureesh
- Staten Island University Hospital, 70 Hancock Street, Unit 1C, Staten Island, NY, 10305, USA
| | - Jia Jian Li
- Staten Island University Hospital, 70 Hancock Street, Unit 1C, Staten Island, NY, 10305, USA
| | - Michel Chalhoub
- Staten Island University Hospital, 70 Hancock Street, Unit 1C, Staten Island, NY, 10305, USA
| |
Collapse
|
12
|
Kim T, Jeon Y, Choi H, Lee JY, Kim J. Endobronchial fungal infection caused by Candida albicans with main bronchus obstruction: a case report. Oxf Med Case Reports 2019; 2019:omz055. [PMID: 31281663 PMCID: PMC6600126 DOI: 10.1093/omcr/omz055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/01/2019] [Accepted: 05/06/2019] [Indexed: 11/13/2022] Open
Abstract
Endobronchial fungal infection (EBFI) is a rare form of pulmonary fungal infection that especially affects immunocompromised patients. Furthermore, EBFI resulting in obstruction of the main bronchus is extremely rare. With the development of bronchoscopic techniques, rare cases of EBFI have been reported. A 68-year-old female was referred to the Department of Pulmonology for confusion and obtundation. The patient was diagnosed with septic shock due to acute pyelonephritis followed by obstructive EBFI. We performed bronchoscopic biopsy and endobronchial aspiration for culture. Biopsy showed yeast-like fungus and Candida albicans grew in the culture. EBFI has been under-recognized because of difficulties in confirming the diagnosis. Endobronchial ultrasound-guided transbronchial needle aspiration and bronchoscopy are used to improve the diagnosis of thoracic infection, such as tuberculosis. The role of bronchoscopy in the diagnosis of infectious diseases of the trachea or main bronchi is expected to widen in the future.
Collapse
Affiliation(s)
- Taeyun Kim
- Department of Pulmonology, Kosin University Gospel Hospital, Busan, South Korea
| | - Yohan Jeon
- Department of Pathology, Kosin University Gospel Hospital, Busan, South Korea
| | - Hyunji Choi
- Department of Laboratory Medicine, Kosin University Gospel Hospital, Busan, South Korea
| | - Jin Young Lee
- Department of Infectious Disease, Kosin University Gospel Hospital, Busan, South Korea
| | - Jehun Kim
- Department of Pulmonology, Kosin University Gospel Hospital, Busan, South Korea
| |
Collapse
|
13
|
Li QH, Su YL, Hou LK, Zhang Y, Hu Y, Shen L, Zhang F, Zhou Y, Li H. Endobronchial aspergilloma associated with idiopathic pulmonary fibrosis: a case report and review of the literature. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2018; 35:95-96. [PMID: 32476887 DOI: 10.36141/svdld.v35i1.6337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/21/2017] [Indexed: 11/02/2022]
Affiliation(s)
- Qiu-Hong Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yi-Liang Su
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Li-Kun Hou
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yuan Zhang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yang Hu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Li Shen
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Fen Zhang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Ying Zhou
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Huiping Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| |
Collapse
|
14
|
Huang D, Li B, Chu H, Zhang Z, Sun Q, Zhao L, Xu L, Shen L, Gui T, Xie H, Zhang J. Endobronchial aspergilloma: A case report and literature review. Exp Ther Med 2017; 14:547-554. [PMID: 28672965 PMCID: PMC5488507 DOI: 10.3892/etm.2017.4540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/23/2017] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to investigate the clinical and radiological characteristics in addition to the bronchoscopic appearance in patients with endobronchial aspergilloma (EBA). Clinical and radiological characteristics were analyzed alongside the bronchoscopic appearance in 17 patients with EBA diagnosed by bronchoscopy with histological examination. The present study assessed the relevant literature and 13 males and 4 females were included in the comparison, with a median age of 59. Associated diseases included 8 previous diagnoses of pulmonary tuberculosis (47.6%), 4 previous diagnoses lung cancer (23.5%), 1 pulmonary resection (5.9%) and 1 bronchial foreign body (5.9%). The primary symptom was hemoptysis (9/17, 53%). Chest computed tomography (CT) indicated a markedly higher incidence of aspergillosis lesion in the left lung (13/17; 76.5%) compared with the right lung (4/17; 23.5%). CT manifestation included space occupying disease in 10 patients (58.8%), aspergilloma in 3 patients (17.6%), pneumonic consolidation in 2 patients (11.8%) and ground glass opacity in 1 patient (5.9%). Bronchoscopy examination identified masses in all 17 patients' bronchial lumen and 15 patients had endobronchial obstruction by necrotic material. The case presented in the current study demonstrated the merits of combining bronchosopic intervention with voriconazole. The dominant symptom of EBA was hemoptysis. Chest CT demonstrated that aspergillosis lesions were more frequently identified in the left lung compared with the right. EBA often occurs in individuals with underlying lung diseases, which cause lumen structural change or bronchial obstruction. EBA may be clearly diagnosed by bronchoscopy biopsy, although the potential for a co-exististing tumor requires consideration. Bronchoscopic intervention and anti-fungal therapy may have an advantage in the effective treatment of patients with EBA.
Collapse
Affiliation(s)
- Dongdong Huang
- Department of Clinical Medicine, Tongji University School of Medicine, Shanghai 200092, P.R. China
| | - Bing Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Haiqing Chu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Zhemin Zhang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Qiuhong Sun
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Lan Zhao
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Liyun Xu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Li Shen
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Tao Gui
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Huikang Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Jun Zhang
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Internal Medicine, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa, IA 52242, USA
| |
Collapse
|
15
|
Slimani H, Soualhi M, Sadak N, Zahraoui R, Bourkadi JE. [Endobronchial aspergilloma revealing a bronchial carcinoma]. Ann Pathol 2016; 36:279-81. [PMID: 27475005 DOI: 10.1016/j.annpat.2016.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 04/15/2016] [Accepted: 04/20/2016] [Indexed: 12/01/2022]
Abstract
Endobronchial aspergillosis is a rare presentation of pulmonary aspergillosis in immunocompetent patients; this raises questions about structural changes inducing airflow stasis in order to colonize the bronchial lumen. We present the case of a patient diagnosed with endobronchial aspergilloma covering a bronchial adenocarcinoma.
Collapse
Affiliation(s)
- Hajar Slimani
- Service de pneumo-phtisiologie, hôpital Moulay-Youssef, CHU Rabat, faculté de médecine et de pharmacie de Rabat, 10000 Akkari, Maroc.
| | - Mouna Soualhi
- Service de pneumo-phtisiologie, hôpital Moulay-Youssef, CHU Rabat, faculté de médecine et de pharmacie de Rabat, 10000 Akkari, Maroc.
| | - Nouzha Sadak
- Service de pneumo-phtisiologie, hôpital Moulay-Youssef, CHU Rabat, faculté de médecine et de pharmacie de Rabat, 10000 Akkari, Maroc.
| | - Rachida Zahraoui
- Service de pneumo-phtisiologie, hôpital Moulay-Youssef, CHU Rabat, faculté de médecine et de pharmacie de Rabat, 10000 Akkari, Maroc.
| | - Jamal-Eddine Bourkadi
- Service de pneumo-phtisiologie, hôpital Moulay-Youssef, CHU Rabat, faculté de médecine et de pharmacie de Rabat, 10000 Akkari, Maroc.
| |
Collapse
|
16
|
Simultaneous Chronic Invasive Fungal Infection and Tracheal Fungus Ball Mimicking Cancer in an Immunocompetent Patient. Case Rep Med 2016; 2016:2416452. [PMID: 27418930 PMCID: PMC4935908 DOI: 10.1155/2016/2416452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/14/2016] [Accepted: 06/07/2016] [Indexed: 11/17/2022] Open
Abstract
Fungal infections of the lung are uncommon and mainly affect people with immune deficiency. There are crucial problems in the diagnosis and treatment of this condition. Invasive pulmonary aspergillosis and candidiasis are the most common opportunistic fungal infections. Aspergillus species (spp.) are saprophytes molds that exist in nature as spores and rarely cause disease in immunocompetent individuals. In patients with immune deficiency or chronic lung disease, such as cavitary lung disease or bronchiectasis, Aspergillus may cause a variety of aspergillosis infections. Here we present a case of a 57-year-old patient without immunodeficiency or chronic lung disease who was diagnosed with endotracheal fungus ball and chronic fungal infection, possibly due to Aspergillus. Bronchoscopic examination showed a paralyzed right vocal cord and vegetating mass that was yellow in color, at the posterior wall of tracheal lumen. After 3 months, both the parenchymal and tracheal lesions were completely resolved.
Collapse
|
17
|
Sunnetcioglu A, Ekin S, Erten R, Parlak M, Esen R. Endobronchial aspergilloma: A case report. Respir Med Case Rep 2016; 18:1-3. [PMID: 27054086 PMCID: PMC4802675 DOI: 10.1016/j.rmcr.2016.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 01/15/2023] Open
Abstract
A 28-year-old male with B-cell acute lymphoblastic leukemia presented to our pulmonary clinic with progressive dyspnea, cough, hemoptysis, and fever. Diagnostic bronchoscopy revealed white masses at the entrance of the right middle lobe bronchus and distal to the right main bronchus. Histopathological examination of the biopsy specimen showed those masses to be hyphae of Aspergillus.
Collapse
Affiliation(s)
- Aysel Sunnetcioglu
- Yuzuncu Yil University Faculty of Medicine, Department of Chest Diseases, Van, Turkey
| | - Selami Ekin
- Yuzuncu Yil University Faculty of Medicine, Department of Chest Diseases, Van, Turkey
| | - Remzi Erten
- Yuzuncu Yil University Faculty of Medicine, Department of Pathology, Van, Turkey
| | - Mehmet Parlak
- Yuzuncu Yil University Faculty of Medicine, Department of Medical Microbiology, Van, Turkey
| | - Ramazan Esen
- Yuzuncu Yil University Faculty of Medicine, Department of Internal Medicine, Van, Turkey
| |
Collapse
|
18
|
Hirano T, Yamada M, Igusa R, Tanno A, Numakura T, Sakamoto K, Kikuchi T, Ichinose M. Two cases of endobronchial aspergilloma complicated with primary and metastatic lung cancer: A case report and literature review. Respir Investig 2016; 54:211-5. [PMID: 27108018 DOI: 10.1016/j.resinv.2015.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/14/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
Endobronchial aspergilloma is a rare and unusual presentation of lung aspergilloma; the natural history for such rare diseases is poorly understood. This report presents two cases of endobronchial aspergilloma complicated by primary and metastatic lung cancer, and summarizes previous reports that suggest that an endobronchial lung cancer lesion may promote the colonialization and growth of Aspergillus species in the bronchus. Therefore, if endobronchial aspergilloma is found, the complication of primary or metastatic endobronchial lung cancer should be carefully considered.
Collapse
Affiliation(s)
- Taizou Hirano
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan; Department of Respiratory Medicine, Oosaki Citizen Hospital, 3-8-1 Furukawahonami Oosaki, Miyagi 989-6174, Japan.
| | - Mitsuhiro Yamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
| | - Ryotaro Igusa
- Department of Respiratory Medicine, Oosaki Citizen Hospital, 3-8-1 Furukawahonami Oosaki, Miyagi 989-6174, Japan.
| | - Atsushi Tanno
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan; Department of Respiratory Medicine, Oosaki Citizen Hospital, 3-8-1 Furukawahonami Oosaki, Miyagi 989-6174, Japan.
| | - Tadahisa Numakura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan; Department of Respiratory Medicine, Oosaki Citizen Hospital, 3-8-1 Furukawahonami Oosaki, Miyagi 989-6174, Japan.
| | - Kazuhiro Sakamoto
- Department of Pathology Medicine, Oosaki Citizen Hospital, 3-8-1 Furukawahonami Oosaki, Miyagi 989-6174, Japan.
| | - Toshiaki Kikuchi
- Division of Respiratory and Infection Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 754-banchi, Asahi-machi-Dori 1-bancho, Chuo-ku, Niigata-shi, Niigata 951-8520, Japan.
| | - Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
| |
Collapse
|
19
|
Aliyali M, Badali H, Shokohi T, Moazeni M, Nosrati A, Godazandeh G, Dolatabadi S, Nabili M. Coinfection of Pulmonary Hydatid Cyst and Aspergilloma: Case Report and Systematic Review. Mycopathologia 2015; 181:255-65. [DOI: 10.1007/s11046-015-9974-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 11/26/2015] [Indexed: 12/28/2022]
|
20
|
An J, Yang HP, Hu CP, Cao LM, Zhou YF, Xiao QM, Pan PH, Luo BL, Meng J, Zheng ZY, Su XL, Li YY. Multinodule abnormalities of the tracheobronchus: bronchoscopy findings and clinical diagnosis. CLINICAL RESPIRATORY JOURNAL 2015; 11:440-447. [PMID: 26260022 DOI: 10.1111/crj.12356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 06/14/2015] [Accepted: 08/03/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Bronchoscopy is an important method for diagnosing respiratory disease. Multiple tracheobronchial nodules are rarely reported and their causes remain unclear. OBJECTIVES The aim of this study was to describe the clinical characteristics of multiple nodule tracheobronchial abnormalities found under bronchoscopy caused by different diseases. METHODS Eighty-seven patients with multiple tracheobronchial nodules were enrolled in this study. The characteristics of the multinodule lesions and the patient were diagnosed based on the pathology findings in our hospital. Chest computed tomography images were retrospectively reviewed by pulmonologists and radiologist. RESULTS In 55 patients with definite pathological diagnosis, 16 (29%) patients were diagnosed as tuberculosis (TB) granuloma; 23 (41.8%) cases were diagnosed as malignant disease; 12 (21.8%) cases were diagnosed as tracheobronchopathia osteochondroplastica; 2 (3.6%) cases were diagnosed as sarcoidosis; and one case (1.8%) was diagnosed as lymphoma and one case (1.8%) as fungal infection. There were 32 cases of chronic inflammation. There was no relationship between nodule distribution and the pathological diagnosis. Malignant nodules usually smaller with a pale outlook, while nodules with larger size and smooth and intact mucosa usually turn out to be granuloma of unknown reason. CONCLUSION The major causes of mutinodule lesions observed using bronchoscopy are tumor and TB. The presence of multiple endotracheobronchial nodules suggest that pulmonary lesion is present, and biopsy should be performed. Malignant nodules can be diagnosed by appearance and biopsy. Pathology results of TB, sarcoidosis and fungal infection can turn out to be granuloma of unknown reason. Further diagnosis needs other clinical materials.
Collapse
Affiliation(s)
- Jian An
- Department of Respiratory & Critical Care Medicine (Key cite of National Clinical Research Center for Respiratory Disease), Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Hua-Ping Yang
- Department of Respiratory & Critical Care Medicine (Key cite of National Clinical Research Center for Respiratory Disease), Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Cheng-Ping Hu
- Department of Respiratory & Critical Care Medicine (Key cite of National Clinical Research Center for Respiratory Disease), Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Li-Ming Cao
- Department of Respiratory & Critical Care Medicine (Key cite of National Clinical Research Center for Respiratory Disease), Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Ya-Fang Zhou
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Qi-Ming Xiao
- Department of Respiratory & Critical Care Medicine (Key cite of National Clinical Research Center for Respiratory Disease), Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Pin-Hua Pan
- Department of Respiratory & Critical Care Medicine (Key cite of National Clinical Research Center for Respiratory Disease), Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Bai-Ling Luo
- Department of Respiratory & Critical Care Medicine (Key cite of National Clinical Research Center for Respiratory Disease), Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Jie Meng
- Department of Respiratory & Critical Care Medicine (Key cite of National Clinical Research Center for Respiratory Disease), Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Zhi-Yuan Zheng
- Department of Respiratory & Critical Care Medicine (Key cite of National Clinical Research Center for Respiratory Disease), Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Xiao-Li Su
- Department of Respiratory & Critical Care Medicine (Key cite of National Clinical Research Center for Respiratory Disease), Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Yuan-Yuan Li
- Department of Respiratory & Critical Care Medicine (Key cite of National Clinical Research Center for Respiratory Disease), Xiangya Hospital, Central South University, Changsha, Hunan province, China
| |
Collapse
|
21
|
Jiang S, Jiang L, Shan F, Zhang X, Song M. Two cases of endobronchial aspergilloma with lung cancer: a review the literature of endobronchial aspergilloma with underlying malignant lesions of the lung. Int J Clin Exp Med 2015; 8:17015-17021. [PMID: 26629257 PMCID: PMC4659145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/06/2015] [Indexed: 06/05/2023]
Abstract
Endobronchial aspergilloma is a rare disease entity with pulmonary involvement of aspergillus. Few cases of endobronchial aspergilloma associated with malignant lesions have been reported in the literature. We present 2 more cases of endobronchial aspergilloma with underlying lung cancer. And summarize the published literatures to investigate the clinical manifestations, bronchoscopic characters, imaging performances in patients with endobronchial aspergilloma with underlying malignant lesions of the lung. A review of the literature reveals 8 cases of endobronchial aspergilloma with coexisting lung malignant lesions upon presentation. The medical details of the patients including age, sex, clinical symptoms, radiological manifestations bronchoscopic characters, diagnosis and treatment are summarized. Endobronchial aspergilloma is usually incidentally detected in patients with underlying lung disease. With the increasing popularity of flexible bronchoscopy, it is being recognized as a necrotic mass causing bronchial obstruction. We should be paid more attention to prevent misdiagnosis of combined endobronchial aspergilloma and lung malignant diseases.
Collapse
Affiliation(s)
- Shenghua Jiang
- Department of Respiratory Hospital Affiliated to Jining Medical College Shandong, 272019, China
| | - Luning Jiang
- Department of Respiratory Hospital Affiliated to Jining Medical College Shandong, 272019, China
| | - Fenglian Shan
- Department of Respiratory Hospital Affiliated to Jining Medical College Shandong, 272019, China
| | - Xiulian Zhang
- Department of Respiratory Hospital Affiliated to Jining Medical College Shandong, 272019, China
| | - Ming Song
- Department of Respiratory Hospital Affiliated to Jining Medical College Shandong, 272019, China
| |
Collapse
|
22
|
Araújo D, Figueiredo M, Monteiro P. Endobronchial aspergilloma: An unusual presentation of pulmonary aspergillosis. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 22:61-2. [PMID: 26299769 DOI: 10.1016/j.rppnen.2015.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 06/29/2015] [Accepted: 07/01/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- D Araújo
- Respiratory Department, CHAA, Guimarães, Portugal.
| | - M Figueiredo
- Respiratory Department, CHAA, Guimarães, Portugal
| | - P Monteiro
- Anatomy Department, CHAA, Guimarães, Portugal
| |
Collapse
|
23
|
Abstract
Infektiöse Lungenerkrankungen oder Pneumonien sind die Haupttodesursache innerhalb der Infektionskrankheiten in Deutschland. Hierbei ist die bakterielle Verursachung am häufigsten. Die Form der Entzündung wird meist durch das schädigende Agens bestimmt, jedoch sind häufig verschiedene Reaktionen anzutreffen. Morphologisch kann nur in wenigen Fällen der Erreger konkret bestimmt werden, sodass meist eine zusätzliche mikrobiologische Erregerdiagnostik notwendig ist. Klinisch erfolgt eine Einteilung in ambulant erworbene und nosokomiale Pneumonien, Pneumonien bei Immunsuppression und die Mykobakteriosen. Histologisch ist eine Einteilung gemäß der bevorzugten Ausbreitung in alveoläre und interstitielle bzw. in lobäre und herdförmige Pneumonien möglich.
Collapse
|
24
|
Affiliation(s)
- Evelise Lima
- Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - André Louis Lobo Nagy
- Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | |
Collapse
|
25
|
Mitchell CA, Kreiger P, Goff C, Shah UK. Pediatric foreign body aspiration: A nidus for Aspergillus colonization. Int J Pediatr Otorhinolaryngol 2015; 79:938-940. [PMID: 25890398 DOI: 10.1016/j.ijporl.2015.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
We describe an immunocompetent child with bronchial fungus following foreign body aspiration. A two-year-old male presented with cough. Workup revealed air trapping and bronchoscopy showed aspirated foreign material in the right mainstem bronchus. Histopathology revealed fungal organisms suggestive of Aspergillus within an ulcer of the adjacent bronchial mucosa. Foreign body aspiration has been posited as a nidus for aspergilloma formation but is not yet described in the available English-language pediatric literature. Here, the foreign body provided a site for fungal growth in the bronchus of an otherwise healthy child. This case suggests that bronchial foreign body may pose risk of fungal colonization even in immunocompetent children.
Collapse
Affiliation(s)
- Candace A Mitchell
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St., 6th Floor, Philadelphia, PA 19107, USA.
| | - Portia Kreiger
- Department of Pathology, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE 19803, USA.
| | - Christopher Goff
- Division of Pediatric Otolaryngology, Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE 19803, USA.
| | - Udayan K Shah
- Division of Pediatric Otolaryngology, Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE 19803, USA; Department of Pediatrics, Thomas Jefferson University, 1020 Walnut St., Philadelphia, PA 19107, USA.
| |
Collapse
|
26
|
Hedayati MT, Azimi Y, Droudinia A, Mousavi B, Khalilian A, Hedayati N, Denning DW. Prevalence of chronic pulmonary aspergillosis in patients with tuberculosis from Iran. Eur J Clin Microbiol Infect Dis 2015; 34:1759-65. [PMID: 26003310 DOI: 10.1007/s10096-015-2409-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/10/2015] [Indexed: 10/23/2022]
Abstract
In patients with preexisting lung disease, especially a cavity, Aspergillus can infect the surface of the cavity, causing chronic cavitary pulmonary aspergillosis (CCPA), and may form an aspergilloma, collectively called chronic pulmonary aspergillosis (CPA). In the present study, we assessed tuberculosis (TB) patients for CPA based on culture and serological methods. During a period of 1 year (from March 2013 to March 2014), we studied 124 patients with TB (94 with current TB and 30 with previous TB) at Masih Daneshvari Hospital in Tehran, Iran. Sputum specimens were analyzed by direct microscopic examination (DME) and fungal culture. The clinical and radiological features of all patients were recorded, to categorize the patients into CCPA and aspergilloma. All patients were screened for serum-specific IgG against A. fumigatus, by enzyme-linked immunosorbent assay (ELISA). Out of 124 patients with TB (66 male, age range: 10-91 years), 48 patients (38.7 %) exhibited residual cavities. Eighteen (14.5 %) patients had cavities with pleural thickening. A round-shaped mass lesion was detected in six patients (6.8 %). DME was positive in ten patients for septate fungal hyphae. A. fumigatus was grown from 14 samples. Fifty-five (44.3 %) cases were positive for serum-specific IgG against A. fumigatus. Of 124 patients with TB, 3 (2.4 %) met criteria for aspergilloma and 14 (11.3 %) for CCPA. CPA is a common clinical presentation in individuals with healed TB in Iran, as reported by previous studies from other countries.
Collapse
Affiliation(s)
- M T Hedayati
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Km 18 Khazarabad Road, P.O. Box 48175-1665, Sari, Iran,
| | | | | | | | | | | | | |
Collapse
|
27
|
Moodley L, Pillay J, Dheda K. Aspergilloma and the surgeon. J Thorac Dis 2014; 6:202-9. [PMID: 24624284 DOI: 10.3978/j.issn.2072-1439.2013.12.40] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/24/2013] [Indexed: 11/14/2022]
Abstract
Aspergillus fungus is a ubiquitous saprophyte that is the causative organism for the development of an aspergilloma. The most common species causing an aspergilloma is the Apergillus fumigatus. An aspergilloma is a conglomeration of mucus, inflammatory cells and altered blood elements. Aspergillomas typically form in pre-existing lung pathology, most notably and commonly in old healed tuberculosis cavities. They are classified into simple and complex types that have clinical relevance. Symptoms are very variable and it is not uncommon to incidentally find a lung aspergilloma. In most case series, the most common presenting symptom is haemoptysis which varies from mild to catastrophic bleeds. Given the limited information about the natural history of the disease, there is unfortunately no recognised factor or variable which can predict how an aspergilloma will manifest itself, hence the manner of treatment is a still a topic of debate among treating physicians. The mainstay of treatment is surgical intervention and medical options although disappointing at the current stage, require further investigation in light of the newer available anti-fungal agents. The need for surgical intervention is however not as clear-cut as one would like, since many patients have multiple co-morbidities and other diffuse or focal lung pathology, making the decision process indeterminate in certain instances. In this review, we focus on the different surgical options available for the management of aspergilloma across variable clinical settings, and we propose an approach to its management.
Collapse
Affiliation(s)
- Loven Moodley
- 1 Chris Barnard Division of Cardiothoracic Surgery, 2 Division of Pulmonology, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Jehron Pillay
- 1 Chris Barnard Division of Cardiothoracic Surgery, 2 Division of Pulmonology, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Keertan Dheda
- 1 Chris Barnard Division of Cardiothoracic Surgery, 2 Division of Pulmonology, Groote Schuur Hospital, University of Cape Town, South Africa
| |
Collapse
|
28
|
Abstract
Pulmonary aspergilloma is caused by colonization and proliferation of Aspergillus in the preexisting cavities in lungs. Diagnosis of pulmonary aspergilloma is usually made based on chest X-ray findings, presence of serum precipitins against aspergillus and sputum culture. Bronchoscopic visualization of aspergilloma is very infrequent and more over calcification is rarely seen. We report a case of pulmonary aspergilloma, which was both calcified and visualized endoluminally during bronchoscopy.
Collapse
Affiliation(s)
- K. A. Vishak
- Department of Pulmonary Medicine, Kasturba Medical College, Attavar, Manipal University, Mangalore, Karnataka, India
| | - A. P. Yogitha
- Department of Pulmonary Medicine, Kasturba Medical College, Attavar, Manipal University, Mangalore, Karnataka, India
| | - A. P. Preetam
- Department of Pulmonary Medicine, Kasturba Medical College, Attavar, Manipal University, Mangalore, Karnataka, India
| | - R. Anand
- Department of Pulmonary Medicine, Kasturba Medical College, Attavar, Manipal University, Mangalore, Karnataka, India
| | - U. B. Naik
- Department of Medicine, Kasturba Medical College, Attavar, Manipal University, Mangalore, Karnataka, India
| |
Collapse
|
29
|
Multiple endobronchial mycetomas with varied appearances and mixed fungal flora. J Bronchology Interv Pulmonol 2013; 20:147-9. [PMID: 23609249 DOI: 10.1097/lbr.0b013e31828ab757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present images of a patient with multiple endobronchial mycetomas visible by bronchoscopy with varying appearances and with mixed fungal flora on culture. A 44-year-old African American male previously treated for pulmonary tuberculosis 11 years earlier presented with moderate hemoptysis and infiltrates in the right upper lobe on chest radiograph. He received levofloxacin without improvement in the infiltrate. Computed tomography scan revealed bronchiectasis, multiple intrabronchial masses, and air crescents. Diagnostic evaluation was negative for acid fast bacilli. Bronchoscopy revealed 4 separate endobronchial masses with varied appearances within dilated bronchiectatic airways. Culture of washings revealed Cunninghamella species, Aspergillus fumigatus, and Penicillium species. The patient underwent a lobectomy and was discharged on an azole antifungal agent, which was discontinued after 6 weeks.
Collapse
|
30
|
Fernández González S, Suarez-Pereiro M, Bollo de Miguel E, Alonso-Orcajo N. Aspergiloma endobronquial. Rev Clin Esp 2013. [DOI: 10.1016/j.rce.2013.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
31
|
Jung SW, Kim MW, Cho SK, Kim HU, Lee DC, Yoon BK, Jeong JP, Ko YC. A Case of Endobronchial Aspergilloma Associated with Foreign Body in Immunocompetent Patient without Underlying Lung Disease. Tuberc Respir Dis (Seoul) 2013; 74:231-4. [PMID: 23750172 PMCID: PMC3672416 DOI: 10.4046/trd.2013.74.5.231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/03/2012] [Accepted: 09/24/2012] [Indexed: 11/24/2022] Open
Abstract
Aspergillus causes a variety of clinical syndromes in the lung including tracheobronchial aspergillosis, invasive aspergillosis, chronic necrotizing pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, and aspergilloma. Aspergilloma usually results from ingrowths of colonized Aspergillus in damaged bronchial tree, pulmonary cyst or cavities of patients with underlying lung diseases. There are a few reports on endobronchial aspergilloma without underlying pulmonary lesion. We have experienced a case of endobronchial aspergilloma associated with foreign body developed in an immunocompetent patient without underlying lung diseases. A 59-year-old man is being hospitalized with recurring hemoptysis for 5 months. X-ray and computed tomography scans of chest showed a nodular opacity in superior segment of left lower lobe. Fiberoptic bronchoscopy revealed an irregular, mass-like, brownish material which totally obstructed the sub-segmental bronchus and a foreign body in superior segmental bronchus of the lower left lobe. Histopathologic examinations of biopsy specimen revealed fungal hyphae, characteristic of Aspergillus species.
Collapse
Affiliation(s)
- Seung Won Jung
- Division of Tuberculosis and Pulmonology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Howard SJ, Pasqualotto AC, Anderson MJ, Leatherbarrow H, Albarrag AM, Harrison E, Gregson L, Bowyer P, Denning DW. Major variations inAspergillus fumigatusarising within aspergillomas in chronic pulmonary aspergillosis. Mycoses 2013; 56:434-41. [DOI: 10.1111/myc.12047] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Yeo CD, Baeg MK, Kim JW. A Case of Endobronchial Aspergilloma Presenting as a Broncholith. Am J Med Sci 2012; 343:501-3. [DOI: 10.1097/maj.0b013e3182425745] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|