Diagnosis of aspergilloma in a pleural cavity (persistent pneumothorax) using classic imaging methods.
The diagnosis of pulmonary aspergillosis is based on serum-analysis, as well as histological and microbiological analysis of bronchial lavage and transbronchial biopsies. When Aspergillus develops within a preformed cavity, however, these tests are likely to be negative. In this situation, classic imaging techniques such as chest X-ray and high resolution-computed tomography (HR-CT) can be of great diagnostic use. We here describe the case of a 62-year-old woman with a history of breast cancer and subsequent ablation of the left breast and radiotherapy. The case demonstrates an example of a pleuropulmonary aspergilloma, in which sero- and micro-biological detection failed. Thorax HR-CT exhibited the cavity, a small persistent pneumothorax, partially filled by an oval density. This density clearly dislocated according to gravity following a positional change of the patient from supine to prone. The density thus revealed mobility which was typical of aspergilloma. Following excision, this diagnosis was confirmed. A density within a cavity may be differentiated by its mobility from differential diagnoses such as lung cancer which would not be expected to exhibit mobility.
Kreymborg
Karsten Grosse
KG
Department of Respiratory Medicine, University of Leipzig, Leipzig, Germany. Karsten_g.Kreymborg@uglc.de
Seyfarth
Hans-Jürgen
HJ
Gessner
Christian
C
Schütz
Alexander
A
Hammerschmidt
Stefan
S
Eichfeld
Ulrich
U
Borte
Gudrun
G
Wirtz
Hubert
H