1 / 6

Penny’s Points Case # 27 Kim Lui M-4 2010

Penny’s Points Case # 27 Kim Lui M-4 2010. A 63 year old man with a history of tuberculosis presents to his primary care physician complaining of a cough. He has recently started coughing up some blood. A CXR and chest CT were obtained. Where is the abnormality?. CT Chest.

william-osborn
Download Presentation

Penny’s Points Case # 27 Kim Lui M-4 2010

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Penny’s Points Case # 27 Kim Lui M-4 2010 A 63 year old man with a history of tuberculosis presents to his primary care physician complaining of a cough. He has recently started coughing up some blood. A CXR and chest CT were obtained.

  2. Where is the abnormality? CT Chest PA Chest X-Ray

  3. Bilateral upper lobe cavaties with intraluminal masses most suspicious for Aspergillous infection- Aspergilloma * *

  4. Aspergillus • Aspergilus spores are typically inhaled into the lungs • Three types of clinical syndromes are commonly associated • Allergic Bronchopulmonary Aspergillosis - presents with recurrent exacerbations of asthma and eosinophilia 2) Pulmonary Aspergilloma - patients with a history of TB, sarcoidosis, histoplasmosis, and bronchiectasis are at greater risk - presents with a chronic cough and hemoptysis 3) Invasive Aspergillosis -when hyphae invade lung vasculature - typically have a compromised immune system (leukemia, transplant recipients, AIDS) - presents with acute onset of fever, cough, respiratory distress, diffuse bilaterl pulmonary infiltrates

  5. Diagnosis • CXR usually reveals a pulmonary consolidation, a fungus ball • Examination of sputum culture will grow Aspergillus species • Microscopic examination will show acute angled branching septated hyphae • Blood samples are rarely positive

  6. Treatment • Asymptomatic aspergilloma usually requires no intervention • Allergic Bronchopulmonary Aspergillosis treatment consists of oral corticosteriods • Cases with mild hemoptysis may be managed wiith antifungals (Amphotericin B, Vorizonazole) • Massive hemoptysis may require emergent operative intervention (arterial embolization)

More Related