PMC5135745_01
CXR showing right upper lobe opacity which on HRCT showed central bronchiectasis in right upper lobe anterior segment
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Fig1
Contrast enhanced CT chest showed mucoid impaction (HAM:High attenuation mucus) and central bronchiectasis in right upper lobe (Fig. 1).
HRCT cuts from 2009 to 2014 showing development of aspergilloma in right upper lobe which grew over 5 years
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Fig2
Subsequently, he had repeated admissions for 3 consecutive years with similar complaints and repeat CT done revealed fibrocalcific lesion in apical and posterior segments of right lung upper lobe with a cavity showing soft tissue attenuation and air crescent sign suggestive of mycetoma (Fig. 2).
A Chest Xray showing opacity right upper lobe B HRCT sagittal cut showing expanded aspergilloma pushing across oblique fissure with peripheral infiltrates
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Fig3
Chest X ray revealed hyperinflated lung fields with focal homogenous opacity with infiltrates in right upper zone (Fig. 3).
A Gross right pneumonectomy specimen with large fungus ball in cavity with fibrosis. B Lung parenchyma blood vessel showing infiltration with fungal hyphae). C Intra bronchial fungal elements. D fungal ball showing acutely branching septate hyphae of Aspergillus
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Fig4
Gross examination of resected lung showed cavity in the upper lobe filled with solid debris (Fig. 4A) which on microscopic examination shows fungal colonies comprising of acutely branching septate fungal hyphae with invasion of surrounding bronchi, alveolar tissues and blood vessels. Surrounding parenchyma showed emphysematous changes with septate branching fungal hyphae and minimal fibrosis of the cavity wall and surrounding pleural consistent with the diagnosis of complex mycetoma with locally invasive aspergillosis (Fig. 4B-D).