Behind the (bilateral) fungus ball

A 54-year-old man with AIDS and a history of Pneumocystis jirovecii pneumonia presented with chronic cough and weight loss for 1 year. There was no haemoptysis. He had normal vital signs and was afebrile. Lung auscultation was normal. Laboratory evaluation was unremarkable. Chest radiography revealed bilateral upper lobe cavities with internal densities (figure 1). CT of the chest demonstrated these apical cavities to contain material consistent with a mycetoma (fungus ball). Adjacent pleural thickening and areas of consolidation and fibrosis were also present (figure 2). A CT scan performed 2 years previously showed normal lung parenchyma. Sputum fungal culture subsequently grew Aspergillus fumigatus. No antifungal therapy was administered, and the patient was eventually lost to follow-up. Figure 1Chest radiograph showing bilateral upper lobe cavitary lesions (arrows) containing mass-like densities (asterisks). Figure 2Chest CT confirmed bilateral intracavitary mycetomas (straight...
Source: Postgraduate Medical Journal - Category: Journals (General) Authors: Tags: Immunology (including allergy), Drugs: infectious diseases, Radiology, Adult intensive care, Pneumonia (respiratory medicine), Dermatology, Clinical diagnostic tests, Radiology (diagnostics) Images in medicine Source Type: research