Lung Pathology: Student/Resident Case Report Poster - Lung Pathology II |

Out of Place: An Endobronchial Aspergilloma FREE TO VIEW

Ryan Dean, DO; Anuj Sharma, MD; Stamatis Baronos, MD; Ashraya Karkee, MD; Ioana Amzuta, MD
Author and Funding Information

Upstate University Hospital, Liverpool, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):815A. doi:10.1016/j.chest.2016.08.911
Text Size: A A A
Published online

SESSION TITLE: Student/Resident Case Report Poster - Lung Pathology II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Aspergillosis is a mycotic disease caused by aspergillus species, most commonly A. fumigatus. The manifestations of pulmonary aspergillosis depend on the patient’s immune status and underlying lung disease. Pulmonary involvement can be classified as pulmonary aspergilloma, allergic bronchopulmonary aspergillosis (ABPA), chronic necrotizing pulmonary aspergillosis and invasive apergillosis. An endobronchial aspergilloma, as presented below, is unusual and is characterized by growth of aspergillus in the bronchial lumen.

CASE PRESENTATION: A 72 year old female with a history of COPD was admitted for a seroquel overdose. She was incidentally noted to have an increase in oxygen requirement and a complete left lung collapse was found on chest xray. A CT thorax with contrast showed an endobronchial mass. On bronchoscopy, mucoid secretions in the left mainstem bronchus were found, however, the patient became hypoxic before evaluation of the endobronchial lesion. A follow up CT thorax showed interval progression of the endobronchial lesion to the level of the carina and complete occlusion of the left mainstem bronchus. Another bronchoscopy was attempted and showed an exophytic, friable, fungating and polypoid mass found at the main carina, extending from the left mainstem. A biopsy was obtained, though complete removal of the mass was unsuccessful. The lesion appeared mobile, acting as a ball and valve moving up the carina. The cultures returned as Aspergillus fumigatus. Infectious disease recommended a total of six to twelve months of voriconazole due to the incomplete removal of the fungal ball. After three months of therapy, she reported interval symptom resolution.

DISCUSSION: In immunocompetent patients, aspergillosis requires structural changes to allow colonization of the bronchial lumen. There are few reports of the fungal growth without preexisting lung cavities or lesions. One such analysis proposed classifying endobronchial aspergillosis without systemic predisposing factors into ABPA, ABPA without asthma, ABPA-seropositive, and endobrochial aspergilloma. The non-invasive, endobronchial type can present as either the sole manifestation or present with other forms of pulmonary aspergillosis. Optimal treatment has not been established as the endobronchial lesion has been thought to represent simple colonization in an immunocompetent host. In pulmonary aspergilloma, surgical resection is favored and while medical therapy usually has no benefit, in an endobronchial lesion, a larger role for medical therapy may be needed, especially, if this is not colonization.

CONCLUSIONS: Endobronachial aspergilloma is a rare presentation of pulmonary aspergillosis. While surgical resection is usually preferred, there may be a role in medical therapy, though this role still needs defining.

Reference #1: Endobronchial Aspergilloma: Report of 10 Cases and Literature Review Yonsei Med J. 2011 Sep 1; 52(5): 787-792. Published online 2011 Jul 18. doi: 10.3349/ymj.2011.52.5.787

DISCLOSURE: The following authors have nothing to disclose: Ryan Dean, Anuj Sharma, Stamatis Baronos, Ashraya Karkee, Ioana Amzuta

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543