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Pulmonary Aspergillosis in Immunocompetent Hosts Without Underlying Lesions of the Lung: Radiologic and Pathologic Findings

Eun-Young Kang1, Dae Hyun Kim1, Ok Hee Woo1, Jung-Ah Choi1, Yu-Whan Oh1 and Chul Hwan Kim2

1 Department of Diagnostic Radiology, College of Medicine, Korea University Guro Hospital, 80 Guro-dong, Guro-ku, 152-050 Seoul, Korea.
2 Department of Pathology, College of Medicine, Korea University Guro Hospital, Guro-ku, 152-050 Seoul, Korea.



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  		Fig. 1A. —31-year-old woman with blood-tinged sputum. Chest radiograph shows 1.5-cm nodule (arrow) in left upper lobe. Solitary pulmonary nodule was only abnormality detected on chest radiography.

 


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  		Fig. 1B. —31-year-old woman with blood-tinged sputum. CT scan (lung window settings, 1-mm collimation) shows well-defined, 1.5-cm nodule with peripheral air crescent in left upper lobe.

 


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  		Fig. 1C. —31-year-old woman with blood-tinged sputum. Photograph of surgical specimen shows well-defined fungal ball forming soft, brown, friable mass. Fibrosis can be seen around cavity.

 


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  		Fig. 1D. —31-year-old woman with blood-tinged sputum. Photomicrograph shows dense collection of fungal hyphae (arrow) within cavity covered by chronic inflammatory granulation tissue. Note surrounding lymphoplasmacytic infiltrate around cavity. (H and E, x40)

 


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  		Fig. 2A. —53-year-old man with sputum and fever. Initial chest radiograph shows ovoid mass (arrows) in right lower lobe and pleural thickening in right lateral hemithorax.

 


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  		Fig. 2B. —53-year-old man with sputum and fever. Enhanced CT scan (soft-tissue window settings, 10-mm collimation) shows 3.5-cm mass located mainly in right lower lobe with internal low-attenuation area. Nodular pleural thickening (arrows) can be seen in right posterior hemithorax.

 


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  		Fig. 2C. —53-year-old man with sputum and fever. Follow-up chest radiograph obtained 1 month after A and B shows mass (arrow) has decreased in size.

 


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  		Fig. 3A. —42-year-old man with hemoptysis. CT scan (soft-tissue window setting, 10-mm collimation) obtained at level of tracheal bifurcation shows triangular-shaped consolidation in left upper lobe. Lesion contains internal low-attenuation area.

 


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  		Fig. 3B. —42-year-old man with hemoptysis. Photograph of surgical specimen shows relatively well-defined, soft brown-gray mass containing gritty brown material. Surrounding tissue appears fibrotic, vaguely nodular. Several dilated bronchi and bronchioles can be seen.

 


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  		Fig. 3C. —42-year-old man with hemoptysis. Photomicrograph shows tangled fungal hyphae (arrows) within cavity and fibrosis and lymphocytic infiltration in surrounding tissue. Inset shows nonnecrotizing granuloma (arrows). (H and E, x40; inset: H and E, x100)

 


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  		Fig. 4A. —41-year-old man with hemoptysis. Chest radiograph shows large consolidation in left lower lobe.

 


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  		Fig. 4B. —41-year-old man with hemoptysis. CT scan (soft-tissue window settings, 10-mm collimation) shows triangular-shaped consolidation with internal low-attenuation areas in left lower lobe.

 

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