title: Lobar Collapse and Obliteration of Air Bronchogram Allowing Early Diagnosis of Endobronchial Aspergillus Infection following Hematopoietic Stem Cell Transplantation.
abstract: Endobronchial fungal infection (EBFI) is notoriously difficult to diagnose early since it may present few systemic features and does not cause characteristic parenchymal lesions on lung CT scanning. We report a 9-year-old girl who suffered extended neutropenia following graft failure after haematopoietic stem cell transplantation (HSCT) for severe aplastic anaemia. CT scan prior to retransplantation was normal despite persistent cough but lobar collapse was shown on repeat scan 16 days later. The probable diagnosis of EBFI (later proven on bronchoscopy) was only suspected when subsequent chest X-ray (CXR) demonstrated lack of an air bronchogram in the partially collapsed lung. Early radiological suspicion resulted in multiagent antifungal therapy followed by delayed lobectomy, and led to this being the first reported case of Aspergillus EBFI not to result in respiratory failure.
authors.affiliation: Faculty of Medicine and Dentistry, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Thompson
authors.affiliation: Department of Radiology, Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK.
authors.forename: Manigandan S
authors.initials: MS
authors.lastname: Thyagarajan
authors.affiliation: PHE Mycology Reference Laboratory, Public Health England Microbiology Services, South West Regional Laboratory Bristol Myrtle Road, Kingsdown, Bristol BS2 8EL, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Johnson
authors.affiliation: Department of Thoracic Surgery, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
authors.forename: David
authors.initials: D
authors.lastname: Weeden
authors.affiliation: Department of Paediatric Haematology, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Morgan
authors.affiliation: School of Cellular & Molecular Medicine, Faculty of Medical Sciences, University of Bristol, University Walk, Bristol BS8 1TD, UK.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Groves
authors.affiliation: School of Cellular & Molecular Medicine, Faculty of Medical Sciences, University of Bristol, University Walk, Bristol BS8 1TD, UK ; Bone Marrow Transplant Unit, Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK.
authors.forename: Colin G
authors.initials: CG
authors.lastname: Steward