title: Pathophysiological study of chronic necrotizing pulmonary aspergillosis.
abstract: The aim of the present study is to define the characteristics of the clinical and histopathological features of chronic necrotizing pulmonary aspergillosis (CNPA) cases with severe hemoptysis. We conducted a histological study of three patients clinically diagnosed as having CNPA who had hemoptysis for 5 years. A tuberculosis sequelae was found as the underlying disorder in all three cases. All patients had fever, general fatigue, and hemoptysis, and their chest computed tomographic images revealed fungus balls, cavity wall thickening, consolidation surrounding the cavity, and satellite foci. All had been treated with anti-fungal drugs and corticosteroids. However, all patients died from respiratory failure due to massive hemoptysis. Histopathological examination revealed that the cavity wall consisted of three layers comprised of necrotic, granulation, and fibrous tissue layers. Aspergilli were found in both the fungus ball and necrotic tissue comprising the inner layer of the cavity. In addition, most of the vessels were incompletely occluded with thrombosis and were necrotic, as well as showing local invasion of Aspergilli. Surgical intervention should be considered as a prior procedure for CNPA patients, because vessels at the cavity wall, whether occluded completely or incompletely, are usually necrotic and/or show local invasion of Aspergilli.
authors.affiliation: Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Sugino
authors.forename: Chikako
authors.initials: C
authors.lastname: Hasegawa
authors.forename: Go
authors.initials: G
authors.lastname: Sano
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Shibuya
authors.forename: Sakae
authors.initials: S
authors.lastname: Homma
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000302:isolation & purification*; D017809:Fatal Outcome; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D008297:Male; D011859:Radiography
chemical_list: D000935:Antifungal Agents