Case 26

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Clinical History:
The patient was a 7 year old female who was status post allogeneic bone marrow transplant for congenital amegakaryocytic thrombocytopenia. Towards the end of her recovery from the bone marrow transplant she developed a fever.

Clinical Physical Exam:
Febrile.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Aspergillosis, Pneumocystis carinii pneumonia

Imaging Findings:
AP chest film showed a cavitary lesion in the right lower lobe. Unenhanced and enhanced chest CT exam from the same day confirmed a cavitary lesion in the right lower lobe that appeared to also have an extrapleural component in the right paraspinal soft tissues.

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Imaging Differential Diagnosis:
Aspergillosis

Operative Findings:
Immediately after the chest CT exam the patient underwent bronchoscopy. Cultures from that procedure grew out Aspergillus. She was placed on Amphotericin, but the lesion progressed. Seven days after the bronchoscopy the patient went to the operating room for a right lower lobe lobectomy and wedge biopsy of the right middle lung. The lesion was partially in the right lower lobe and was partially extrapleural.

Pathological Findings:
Pathological examination of the surgical specimen revealed the presence of aspergillosis

Final Diagnosis:
Aspergillosis

Follow-up and Prognosis:
The patient had a stormy postoperative course which resulted in multisystem organ failure and the patient died 16 days after the lobectomy.

Similar Cases:
Case 12, Case 54

References:

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