1. IMAGE OF THE WEEK
M7 UNIT
PROF DR.THILAKAVATHI.R M.D
DR.MADHUSUDHANAN M.D
DR.ELANGOVAN M.D
BY DR.DHARANI L
(FIRST YEAR POSTGRADUATE)
2. CASE HISTORY
A 45 year old male presented with
C/O cough with expectoration for 1 month
C/O decreased appetite
C/O hemoptysis – 2 episodes each around 2-3 ml
of blood in sputum
3. PAST HISTORY
Not a known case of Pulmonary TB/T2DM/SHTN
Not a known case of CVA, CAD, CKD
No H/o covid 19 infection, both dose vaccinated
PERSONAL HISTORY
Mixed diet
Normal bowel and bladder habbits
Known occasional alcoholic for past 10 years
Known chronic smoker for past 20 years ( 1 pack
/day)
4. ON EXAMINATION
Patient conscious
Oriented
Afebrile
Hydration fair
Clubbing – Grade II
BP- 120/70, PR- 108/ min, SPO2-96% in RA
CVS: S1S2 +, No murmur
RS: trachea in midline ,trial sign negative,
Normal vescicular breath sounds heard in all areas except left
supraclavicular and infraclavicular areas
Impaired resonance in left supraclavicular and supraclavicular
areas
VF, VR reduced in above areas
P/A: Soft, BS+, No organomegaly
CNS: No focal neurological deficit
7. INTERPRETATION
Frontal view of xray chest
Full inspiratory film
Adequate exposure
Overpenetration present
Trachea mildly deviated to left
B/L lung field appears hyperinflated
Mediastinum appears to be mildly shifted towards
left
Left cardiophrenic angle appears to be blunted
A heterogenous opacity noted in the left upper zone
with air around the opacity taking crescent shape
8. DIFFERENTIAL DIAGNOSIS
LEFT UPPER LOBE MASS
Tuberculosis
Single pulmonary nodule
Consolidation
Fungal ball- Aspergilloma
Abscess
Malignancy
11. CT REPORT
A well defined special soft tissue density mass of
4*3 cm in apicoposterior segment of left upper
lobe with eccentric air locule taking crescent shape
– suggestive of aspergilloma
13. DIAGNOSIS
A thin walled cavity with fungal ball aspergilloma –
probably post TB sequela
14.
15.
16.
17.
18. CT REPORT
Fibrocavity measuring 3x2 cm in left upper lobe
apicoposterior segment with heterodense calcified
intracavitory body noted within the cavity
Surrounded by crescent of air
Multifocal patchy fibrosis noted in the left upper
lobe with traction bronchiectatic changes
Possibly old infective sequela with fungal ball
19. SINGLE PULMONARY NODULE
Well defined round or
oval </= 3 cm in
diameter surrounded
by pulmonary
parenchyma
23. CHRONIC PULMONARY
ASPERGILLOSIS
It is a chronic progressive and destructive
parenchmal lung infection
90 % in patients with current or previous underlying
lung disease or immune deficit
Radiological presentation with formation of new
cavities or expansion of existing ones +/- fungal ball
or nodule
27. ASPERGILLUS NODULES
Occurs in immunocompetent hosts
May be single/multiple with or without cavitation
Patient are usually asymptomatic or have minor
pulmonary symptoms
Aspergillus IgG titre may be rised
Natural history is poorly described , but prognosis is
good
28. A SINGLE ASPERGILLOMA
Single pulmonary aspergilloma is a single fungal
ball in a single pulmonary cavity
Serological / microbiological evidence may
implicate Aspergillus spp
No radiological progression over months of
observation
Persistent pulmonary/ systemic symptoms
Can be complicated by sudden , potentially fatal
hemoptysis
MONAD SIGN – change of fungal ball position
within the cavity
29.
30. CHRONIC CAVITARY PULMONARY
ASPERGILLOSIS
Formation or expansion of existing cavities (usually
multiple ) is charecteristic
cavities may or may not contain an
aspergilloma ( fungal ball)
Associated with high mortality (50-85% at 5 years)
cause of death include severe haemoptysis
and respiratory failure
Mostly associated with underlying defect in innate
immunity
31.
32. CHRONIC FIBROSING PULMONARY
ASPERGILLOSIS
Extensive fibrosis with fibrotic destruction of atleast
two lobes of lung
With major loss of lung function
Represent an end result of untreated CCPA
One or more aspergillomas may be present
Seroloical/microbiological evidence is required for
diagnosis
34. HALO SIGN
Ground glass opacity
surrounding a
pulmonary nodule
represents
hemorrhage- in active
phase of IPA
35. AIR CRESCENT SIGN
Half moon shaped lung tissue
In recovery phase –peripheral absorption of
necrotic tissue causes the retraction of infarcted
area