PMC4356032_01
Axial images from Thoracic Computed Tomography (CT) scans acquired in a 32-year old leukaemic patient with Invasive Pulmonary Aspergillosis (IPA). The selected images, which are from identical slice positions, demonstrate bilateral ground glass opacification on Day 21 ((a)) and new intrapulmonary fungal mass lesions, which had developed by the time of repeat scanning on Day 47 ((b)).
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Serial chest radiographs followed by thoracic Computed Tomography (CT) scanning on Day 28 revealed progressive, extensive ground glass opacification (see Fig. 1(a)). Repeat CT imaging on Day 44 demonstrated additional intrapulmonary mass lesions (see Fig. 1(b)).
Selected axial (a) and coronal (b) images from a Thoracic Computed Tomography (CT) scan acquired on Day 96 in a patient with Invasive Pulmonary Aspergillosis (IPA). There is a left-sided tension pneumothorax and subcutaneous emphysema due to a large alveolar-pleural fistula resulting from rupture of a fungal mass lesion (*).
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Digital thoracic drainage units (Thopaz , Medela, Switzerland) demonstrated a consistent PAL in excess of 2000 ml/min, likely due to a ruptured fungal cavity in the lingular subsegment, which was demonstrated on a third CT scan on Day 96 (see Fig. 2).
A single axial image from a Thoracic Computed Tomography (CT) scan acquired on Day 110 in a leukaemic patient with Invasive Pulmonary Aspergillosis (IPA). A 4 mm endobronchial valve (Zephyr , Pulmonx Inc. Neuchatel, Switzerland) is demonstrated within the lingular segmental bronchus proximal to an alveolar-pleural fistula caused by rupture of a fungal mass lesion. There has been a significant improvement in the previously demonstrated left-sided pneumothorax.
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Repeat CT imaging 2 weeks later demonstrated satisfactory positioning of the EBV and significant lung re-expansion (see Fig. 3).