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Wednesday, September 9, 2015

A 65 Year Old Man Presents With Cough And Hemoptysis

A 65 year old man presents with a severe dry cough accompanied by rusty blood streaked sputum, that started 2 days ago. He had a past history of tuberculosis and he is a chronic smoker. He denies having any fever. His chest X ray is shown below;

The x ray shows a classic finding of a fungus ball ( upper right ) in an old tuberculosis cavity. This finding is typical of an Aspergilloma.

Case Discussion:
Aspergilloma is due to colonization by the species Aspergillus fumigatus rather than direct tissue invasion, and is usually not an indicator of an immuno - compromised state. It arises most commonly in old tuberculous cavities but may occur in cavities created by neoplasms, sarcoidosis and other fungal infections such as histoplasmosis.
The aspergilloma comprises fungal hyphae, inflammatory cells and fibrin.
Clinically, patients may be asymptomatic but the vast majority experience haemoptysis. Some patients complain of chest pain, wheeze and a fever.
The diagnosis is made with radiological tests. The chest X-ray is usually diagnostic but confirmation of the aspergilloma may require a CT scan or MRI scan of the thorax. The identification of Aspergillus in the sputum in such patients is highly suggestive of the diagnosis.
Treatment: Patients with recurrent haemoptysis are treated with surgical resection of the cavity and removal of the aspergilloma.

List the causes for Cavitating Lung lesions:


Causes of cavitating lung lesions

1. Infections
• Staphylococcus aureus pneumonia
• Klebsiella pneumonia
• Pseudomonas colonization
• Tuberculosis
• Histoplasmosis
• Hydatid disease

2. Neoplasia
• Benign
• Malignant (Primary Or Secondary)

3. Vascular
• Pulmonary emboli
• Vasculitides

4. Granulomatous disease
• Sarcoidosis

1 comment:

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