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Joseph Junewick, MD FACR
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Aspergillus Pneumonia Immune-Competent

Case Detail

Anatomy: Chest
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 4 years ago
Updated: over 3 years ago
Tags: PEDS
Modality/Study Types: CT
Activities:
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History

Immune competent child with fever.


Case Images


Diagnosis

Aspergillus Pneumonia.

Findings

CT – Tree in bud left lower lobe infiltrate.

Discussion

Patterns of pulmonary aspergillosis are variable and largely dependent upon the patient’s immune status and underlying lung status (aspergilloma in immunocompetent patients, semiinvasive aspergillosis in immune suppressed patients, invasive pulmonary aspergillosis in immunocompromised patients, and allergic bronchopulmonary aspergillosis in hypersensitive patients). An aspergilloma is a freely mobile mass of Aspergillus mycelia that accumulates in a bulla or cyst (usually related to previous pneumonia, bronchiectasis, pneumoconiosis, sarcoidosis, and tuberculosis). The air crescent sign is the result of a mobile fungus ball incompletely filling a thin-walled cavity. The lesion is usually single but may be multiple. Aspergillomas occur predominantly in the upper lobes, probably reflecting the predilection for cavity formation. Pneumonia can be caused by Aspergillus in immunocompetent hosts without preexisting disease usually secondary to a massive inoculum of Aspergillus. In an immunocompromised patient, the inhaled fungus infiltrates bronchus and pulmonary artery, producing pneumonia and pulmonary infarction. Primary invasive aspergillosis manifests as bilateral diffuse infiltrates or localized infiltrates that progress to diffuse infiltrates radiographically whereas secondary invasive aspergillosis is variable and nonspecific (varying from a normal appearance early in the disease to focal or diffuse peripheral infiltrates that can progress to large areas of consolidation).

Reference

Kang EY, Kim DH, Woo OH, et al. Pulmonary Aspergillosis in Immunocompetent Hosts Without Underlying Lesions of the Lung: Radiologic and Pathologic Findings. AJR (2002); 178:1395-1399.



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