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Semiinvasive Pulmonary Aspergillosis

CT and Pathologic Findings in Six Patients

Su Young Kim1, Kyung Soo Lee1, Joungho Han2, Jhingook Kim3, Tae Sung Kim1, Sung Wook Choo1 and Sang Jin Kim4

1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
2 Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
3 Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
4 Department of Diagnostic Radiology, Yongdong Severance Hospital, Yonsei University Medical College, 6-17, Dogok-Dong, Kangnam-Ku, Seoul 135-612, Korea.



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  		Fig. 1A. —49-year-old woman with semiinvasive pulmonary aspergillosis and history of pulmonary tuberculosis and cerebral palsy. Enhanced CT scan (7-mm collimation) obtained at subcarinal level shows lobar consolidation in left upper lobe. Note internal cavity filled with air and low-attenuation soft tissue (arrows). Pleural thickening (arrowhead) is also seen.

 


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  		Fig. 1B. —49-year-old woman with semiinvasive pulmonary aspergillosis and history of pulmonary tuberculosis and cerebral palsy. Cut surface of gross pathology specimen obtained at level similar to A shows destroyed lung with parenchymal fibrous scarring. Note abscessed cavity containing mudlike aspergilloma (arrows) corresponding to low-attenuation area seen in A.

 


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  		Fig. 2A. —67-year-old woman with semiinvasive pulmonary aspergillosis and history of diabetes and bronchiectasis. Enhanced CT scan (7-mm collimation) obtained at ventricular level shows enhancing consolidation with internal round low-attenuation area (arrow) in left lower lobe. Note volume decrease in left lower lobe and pleural thickening (arrowhead).

 


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  		Fig. 2B. —67-year-old woman with semiinvasive pulmonary aspergillosis and history of diabetes and bronchiectasis. Cut surface of gross pathology specimen shows fibrotic consolidation with anthracotic pigmentation (arrows) and central bronchiectasis containing aspergilloma (arrowhead). Note pleural thickening (open arrow).

 


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  		Fig. 3. —53-year-old man with semiinvasive pulmonary aspergillosis and history of diabetes and pulmonary emphysema. Thin-section CT scan (1.0-mm collimation) obtained at level of aortic arch reveals area of consolidation and surrounding ground-glass opacity in left upper lobe. Note underlying emphysema.

 


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  		Fig. 4A. —36-year-old woman with semiinvasive pulmonary aspergillosis and history of diabetes. Enhanced CT scan obtained at ventricular level reveals round low-attenuation soft-tissue lesion in left lower lobe. Note anterior enhancing rim.

 


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  		Fig. 4B. —36-year-old woman with semiinvasive pulmonary aspergillosis and history of diabetes. Pathology specimen reveals active inflammation with granulation tissue (straight arrows) and many small cysts containing Aspergillus species (open arrows). Note lymphoid follicles (curved arrows). (Periodic acid-Schiff stain, x40)

 

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