PMC5120194_01
View of the trachea during bronchoscopy. Note the obstruction of >50% of the tracheal lumen by whitish thick secretions.
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An estimated 50-60% of the entire tracheal lumen was filled with thick, whitish secretions, in addition to a mucosal pseudomembrane that was visualized down to the carina (Figure 1).
View of the carina during bronchoscopy. Note the thick, pseudomembranous white material obstructing a great portion of both mainstem bronchi and the optical foreign body forceps in place used to gently remove these.
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fig2
After mechanical removal of the secretions and pseudomembranes (Figure 2), she was left intubated and readmitted to the intensive care unit for further care.
Grocott's methenamine silver stain of a piece of pseudomembrane obtained during bronchoalveolar lavage showed dichotomously branched and septate hyphae, suggestive of the diagnosis of Aspergillus. 400-fold magnification.
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Microscopic examination of the debris obtained by bronchoalveolar lavage confirmed fungal elements consistent with Aspergillus fumigatus (Figure 3).
Autopsy: posterior view of left bronchial tree demonstrating the complete filling of even most distal airways with yellow gelatinous material.
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The entire bronchial tree was lined with tan-yellow material and all lumen were narrowed or obstructed at the level of the small intrasegmental bronchi (Figures 4 and 5).
Autopsy: coronal cut through lung demonstrating peribronchial congestion and hemorrhage.
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fig5
The entire bronchial tree was lined with tan-yellow material and all lumen were narrowed or obstructed at the level of the small intrasegmental bronchi (Figures 4 and 5).
Histopathology: 10-fold magnification and H+E stain of a large bronchus demonstrating an entirely obstructed lumen.
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There was peribronchial congestion and hemorrhage (Figure 6), as well as hilar and mediastinal lymphadenopathy.