Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
The patient was an 8 year old female status post bone marrow transplant for myelodysplastic syndrome 33 days ago who developed a cough.
Clinical Physical Exam:
Clinical Differential Diagnosis:
Aspergillosis, Pneumocystic Carinii Pneumonia
Chest films demonstrated a lesion in the right lung which was confirmed on a chest CT exam performed 3 days later.
Images 1 and 2
Imaging Differential Diagnosis:
Three days after the chest CT exam the patient underwent a thoracotomy and wedge resection of the right lower lobe to remove the aspergilloma. The lesion was found to be in the apical segment of the right lower lobe.
Pulmonary infarction with cavitation and fungal overgrowth were seen. Angioinvasive septate branching hyphae, consistent with aspergillosis, were also seen.
Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. She was placed on amphotericin and then switched to itraconazole.
Case 26, Case 54
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