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Semiinvasive Pulmonary Aspergillosis in Chronic Obstructive Pulmonary Disease

Radiologic and Pathologic Findings in Nine Patients

Tomás Franquet1, Nestor L. Müller2, Ana Giménez1, Pere Domingo3, Vicente Plaza3 and Ramón Bordes4

1 Department of Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, San Antonio M. Claret 167, 08025 Barcelona, Spain.
2 Department of Radiology, University of British Columbia and Vancouver Hospital and Health Sciences Centre, 855 W. 12th Ave., Vancouver, British Columbia, V5Z 1M9 Canada.
3 Department of Internal Medicine, Hospital de Sant Pau, Universidad Autónoma de Barcelona, 08025, Barcelona, Spain.
4 Department of Pathology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, 08025, Barcelona, Spain.



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  		Fig. 1. —Semiinvasive pulmonary aspergillosis in 72-year-old man with centrilobular emphysema and 2-month history of cough and chest discomfort at presentation.

A, Posteroanterior chest radiograph shows peripheral and right apical air-space consolidation.

 


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  		Fig. 1. —Semiinvasive pulmonary aspergillosis in 72-year-old man with centrilobular emphysema and 2-month history of cough and chest discomfort at presentation.

B, CT scan obtained at same level as A shows segmental air-space consolidation in posterior segment of right upper lobe that contains multiple low-attenuation areas (arrowheads), small air bubbles, and punctate calcifications.

 


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  		Fig. 1. —Semiinvasive pulmonary aspergillosis in 72-year-old man with centrilobular emphysema and 2-month history of cough and chest discomfort at presentation.

C, Photomicrograph of biopsy specimen obtained from right upper lobe reveals widespread intraalveolar exudative eosinophil material mixed with acute inflammatory cells, macrophages, and fungal hyphae (straight arrows). Microabscess containing Aspergillus fumigatus colonies (curved arrows) corresponds to low-attenuation areas seen on B. (H and E, x400)

 


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  		Fig. 2. —Semiinvasive aspergillosis in 68-year-old man with chronic bronchitis and recurrent episodes of mild hemoptysis.

A, Thin-section (2-mm collimation) CT scan obtained with lung windows shows rounded area of consolidation with associated cavitation in left upper lobe.

 


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  		Fig. 2. —Semiinvasive aspergillosis in 68-year-old man with chronic bronchitis and recurrent episodes of mild hemoptysis.

B, Photograph of left upper lobe pathologic specimen from autopsy shows irregular cavitary lesion with regular margins and dark-brown appearance, consisting of necrotic material and Aspergillus organisms.

 


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  		Fig. 2. —Semiinvasive aspergillosis in 68-year-old man with chronic bronchitis and recurrent episodes of mild hemoptysis.

C, Photomicrograph of pathologic specimen shows cavitary lesion containing fungal septate hyphae branching at an acute angle, which is morphologically consistent with aspergillosis. Wall of abscess shows mild inflammatory reaction. Surrounding pulmonary parenchyma is healthy. (H and E, x400)

 


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  		Fig. 3. —Multiple bilateral nodules and cavitary aspergillosis in left upper lobe in 54-year-old man with chronic bronchitis and recurrent episodes of hemoptysis.

A, Posteroanterior chest radiograph shows multiple nodular opacities in left lung (straight arrows); paramediastinal ill-defined density is also visible (curved arrow).

 


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  		Fig. 3. —Multiple bilateral nodules and cavitary aspergillosis in left upper lobe in 54-year-old man with chronic bronchitis and recurrent episodes of hemoptysis.

B, Thin-section CT scan confirms presence of bilateral, multiple, ill-defined nodules of various sizes. Cavitation with presence of air crescent, not seen on conventional radiography, was easily shown by CT.

 


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  		Fig. 3. —Multiple bilateral nodules and cavitary aspergillosis in left upper lobe in 54-year-old man with chronic bronchitis and recurrent episodes of hemoptysis.

C, Patient died 4 months after CT examination shown in B. At autopsy, aspergillosis abscesses and multiple small bronchial and bronchiolar yellowish nodules corresponding to fungal bronchitis were found. Photomicrograph shows massive Aspergillus hyphae invading bronchial and bronchiolar epithelium (arrows). (H and E, x400)

 


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  		Fig. 4. —Semiinvasive pulmonary aspergillosis in 56-year-old man with chronic bronchitis and history of tuberculosis.

A, Posteroanterior chest radiograph obtained 6 months before presentation shows chronic bilateral upper lobe infiltrates with associated calcified granulomas consistent with previous tuberculosis (arrows). Perihilar irregular linear opacities are also seen.

 


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  		Fig. 4. —Semiinvasive pulmonary aspergillosis in 56-year-old man with chronic bronchitis and history of tuberculosis.

B, Posteroanterior chest radiograph obtained at time of presentation shows significant progression of upper lobe infiltrates.

 


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  		Fig. 4. —Semiinvasive pulmonary aspergillosis in 56-year-old man with chronic bronchitis and history of tuberculosis.

C, Thin-section CT scan at level of upper lobes shows bilateral parenchymal consolidation in both upper lobes.

 


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  		Fig. 4. —Semiinvasive pulmonary aspergillosis in 56-year-old man with chronic bronchitis and history of tuberculosis.

D, Postmortem microscopic examination confirmed fungal infection caused by Aspergillus fumigatus. Photomicrograph from small area of consolidation shows tissue necrosis. Aspergillus hyphae (arrows) could be identified in necrotic tissue. (H and E, x400)

 

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