223Lu Chronic Pulmonary Aspergillosis (CP) TB and Acute Pneumonia

CXR with Cavitation  in the Left Lung Apex and Lingula Infiltrate

CXR with Cavitation  in the Left Lung Apex and Lingula Infiltrate
46 year old immunocompromised male presents with a fever.  CXR shows a cavitating nodule in the left apex and a lingula infiltrate partially silhouetting the left heart border.
Ashley Davidoff TheCommonVein.net

CXR with Lingula Infiltrate

CXR with Lingula Infiltrate
46 year old immunocompromised male presents with a fever.  Lateral CXR shows a lingula infiltrate,  partially silhouetting the left heart border better seen in the magnified view.
Ashley Davidoff TheCommonVein.net

 

CT with Cavitation  in the Left Lung Apex and Lingula Infiltrate

CT with Cavitation  in the Left Lung Apex and Lingula Infiltrate
46 year old immunocompromised male presents with a fever.  Scout for the CT scan  shows a cavitating nodule in the left apex and a lingula infiltrate partially silhouetting the left heart border.
Ashley Davidoff TheCommonVein.net

CT shows Small Air Bubble in Right Apex and Calcification in a Nodule in the Left Apex ? Colonized Aspergillomas in TB Cavities Probable Chronic Pulmonary Aspergillosis 

46 year old immunocompromised male  with a fever.  CT shows small cavitating  right apical spiculated nodule and calcifications in a left apical spiculated nodule . Diagnosis probable Chronic Pulmonary Aspergillosis with Aspergillomas in TB cavities
Ashley Davidoff TheCommonVein.net

CT – Large Biapical Cavities Likely TB in origin with Colonized Aspergillomas 

CT – Large Biapical Cavities Likely TB in origin with Colonized Aspergillomas 
46 year old immunocompromised male  with a fever.  CT shows small biapical cavitations with internal solid debris  .
Diagnosis probable Chronic Pulmonary Aspergillosis with Aspergillomas in TB cavities
Ashley Davidoff TheCommonVein.net

CT with Lingula Infiltrate

CT with Lingula Infiltrate
46 year old immunocompromised male  presents with a fever.  Axial  CT shows a subsegmental lingula infiltrate, abutting and silhouetting the left heart border 
Ashley Davidoff TheCommonVein.net

Discussion

The case without further clinical history

The aspergillus infection diagnosis was presumably made on the basis of sputum and serological testing.  There is no obtainable  history regarding tuberculosis.  However the presence of biapical disease and calcifications in the left apex, raises the suspicion of colonization of TB cavities and hence the diagnosis of chronic pulmonary aspergillosis seems likely.  The pneumonia in the lingula is likely an unrelated problem, possibly secondary to immunocompromise .