Date: 21 January 2014
The chest is distorted by a deformity of the back and ribs.
Copyright: n/a
Notes:
This patient’s X-ray is complex. The chest is distorted by a deformity of the back and ribs. Substantial metalwork following a spinal fusion is in place to support the vertebral column and part of this overlies the heart and part of it crosses the left lung. The patient also has a portacath device in-situ over the right lung, which allows i.v. antibiotics to be given. A needle is in-situ inside the portacath device. An external drainage tube is currently in-situ in a large air cavity and left upper thorax. This cavity contains mostly air but there is some fluid with the fluid level at its base. Underneath this large pyopneumothorax is a normal component of left lower lobe. The heart is very substantially moved to the right of the lung because of a previous right lower lobe resection. There is no evidence of aspergillosis on this x-ray as it stands.
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Nodules and areas of atelectasis are seen at both bases. He later died.
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Further details
It is clearly a relatively small cavitary lesion, and the patient was almost asymptomatic. This response was a ‘stable’ response. The patient was included in the report Denning DW, Lee JY, Hostetler JS, Pappas P, Kauffman CA, Dewsnup DH, Galgiani JN, Graybill JR, Sugar AM, Catanzaro A, Gallis H, Perfect JR, Dockery B, Dismukes WE, Stevens DA, NIAID Mycoses Study Group multicenter trial of oral itraconazole therapy of invasive aspergillosis. Am J Med 1994; 97: 135-144.
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Well demarcated pulmonary infarction is well seen in this close-up of the lung at autopsy in a patient with histologically confirmed invasive aspergillosis. Angio invasion is characteristic of invasive aspergillosis, is associated with a worse prognosis, but is not always seen.
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This 83 year old man presented with weight loss to a lung cancer clinic in mid 2003.
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