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A case of invasive pulmonary aspergillosis with direct invasion of the mediastinum and the left atrium in an immunocompetent patient.

Han KH, Kim JH, Shin SY, Jeong HY, Chu JM, Kim HS, Kim D, Shim M, Cho SH, Kim EK - Tuberc Respir Dis (Seoul) (2014)

Bottom Line: The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left.The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver.Despite the treatment with antifungal agents, she died from cardiac tamponade after three months.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

ABSTRACT
We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.

No MeSH data available.


Related in: MedlinePlus

The chest computed tomography scan shows the mediastinal mass compressing the right atrium and the right ventricle (arrowheads). The mediastinal mass is connected to the left atrium, the right hilum, and subcarina (arrows).
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Figure 2: The chest computed tomography scan shows the mediastinal mass compressing the right atrium and the right ventricle (arrowheads). The mediastinal mass is connected to the left atrium, the right hilum, and subcarina (arrows).

Mentions: A 70-year-old woman visited our hospital for mild dyspnea, cough, and sputum on March 6, 2012. She had been in a well-controlled state of her diabetes and hypertension since 2000. The level of glycosylated hemoglobin A1c was 6.1% on admission. She had no other medical history and did not administer medications such as corticosteroid or antibiotics. On admission, body temperature was 37.4℃, blood pressure 100/70 mm Hg, and pulse rate 92 beats per minute. Breath sounds were diminished over the right lung. The laboratory test showed a white blood cell count of 7,760/µL and a C-reactive protein of 0.39 mg/dL. A plain chest radiograph showed prominent mass opacity in the right hilum (Figure 1). A computed tomography (CT) scan of the chest revealed an ill-defined poorly enhanced mediastinal mass invading the subcarina, the right hilum, and the left atrium, a protruding lesion in the right bronchus intermedius, peribronchovascular interstitial thickening around the right bronchus, and a small amount of pleural effusion in the right hemithorax. The mass in the mediastinum compressed the right atrium and the right ventricle (Figure 2). The diagnostic thoracentesis revealed a lymphocyte dominant exudate, a white blood cell count of 1,630/µL (lymphocyte 43%), albumin of 2.2 g/dL, lactate dehydrogenase of 883 U/L, glucose of 210 mg/dL, and adenosine deaminase of 15I U/L. The cytologic examination observed no malignant cells in the pleural effusion. A CT-guided percutaneous needle aspiration biopsy (PCNA) of the mediastinal mass was conducted. The pathology revealed necrotic tissues only with no evidence of malignancy. In the fiberoptic bronchoscopy, the orifice of the right bronchus intermedius was nearly totally obstructed by a bloody mass (Figure 3). The pathology from the bronchoscopic biopsy observed abundant fungal hyphae. The result of stains with periodic acid-Schiff and Gomori's methenamine silver for fungi was positive for fungal hyphae, and the acid-fasting staining showed a negative result for acid-fast bacilli (Figure 4). The serologic test for Aspergillus fumigatus was negative. An echocardiography showed an ejection fraction of 63% and normal global left ventricular systolic function with no regional wall motion abnormality. However, there was a huge mediastinal mass compressing the heart and a hyperechoic polypoid lesion in the left atrium (Figure 5). She was diagnosed with invasive pulmonary aspergillosis involving the heart and thus, amphotericin B (0.25 mg/kg/day) was prescribed intravenously.


A case of invasive pulmonary aspergillosis with direct invasion of the mediastinum and the left atrium in an immunocompetent patient.

Han KH, Kim JH, Shin SY, Jeong HY, Chu JM, Kim HS, Kim D, Shim M, Cho SH, Kim EK - Tuberc Respir Dis (Seoul) (2014)

The chest computed tomography scan shows the mediastinal mass compressing the right atrium and the right ventricle (arrowheads). The mediastinal mass is connected to the left atrium, the right hilum, and subcarina (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127410&req=5

Figure 2: The chest computed tomography scan shows the mediastinal mass compressing the right atrium and the right ventricle (arrowheads). The mediastinal mass is connected to the left atrium, the right hilum, and subcarina (arrows).
Mentions: A 70-year-old woman visited our hospital for mild dyspnea, cough, and sputum on March 6, 2012. She had been in a well-controlled state of her diabetes and hypertension since 2000. The level of glycosylated hemoglobin A1c was 6.1% on admission. She had no other medical history and did not administer medications such as corticosteroid or antibiotics. On admission, body temperature was 37.4℃, blood pressure 100/70 mm Hg, and pulse rate 92 beats per minute. Breath sounds were diminished over the right lung. The laboratory test showed a white blood cell count of 7,760/µL and a C-reactive protein of 0.39 mg/dL. A plain chest radiograph showed prominent mass opacity in the right hilum (Figure 1). A computed tomography (CT) scan of the chest revealed an ill-defined poorly enhanced mediastinal mass invading the subcarina, the right hilum, and the left atrium, a protruding lesion in the right bronchus intermedius, peribronchovascular interstitial thickening around the right bronchus, and a small amount of pleural effusion in the right hemithorax. The mass in the mediastinum compressed the right atrium and the right ventricle (Figure 2). The diagnostic thoracentesis revealed a lymphocyte dominant exudate, a white blood cell count of 1,630/µL (lymphocyte 43%), albumin of 2.2 g/dL, lactate dehydrogenase of 883 U/L, glucose of 210 mg/dL, and adenosine deaminase of 15I U/L. The cytologic examination observed no malignant cells in the pleural effusion. A CT-guided percutaneous needle aspiration biopsy (PCNA) of the mediastinal mass was conducted. The pathology revealed necrotic tissues only with no evidence of malignancy. In the fiberoptic bronchoscopy, the orifice of the right bronchus intermedius was nearly totally obstructed by a bloody mass (Figure 3). The pathology from the bronchoscopic biopsy observed abundant fungal hyphae. The result of stains with periodic acid-Schiff and Gomori's methenamine silver for fungi was positive for fungal hyphae, and the acid-fasting staining showed a negative result for acid-fast bacilli (Figure 4). The serologic test for Aspergillus fumigatus was negative. An echocardiography showed an ejection fraction of 63% and normal global left ventricular systolic function with no regional wall motion abnormality. However, there was a huge mediastinal mass compressing the heart and a hyperechoic polypoid lesion in the left atrium (Figure 5). She was diagnosed with invasive pulmonary aspergillosis involving the heart and thus, amphotericin B (0.25 mg/kg/day) was prescribed intravenously.

Bottom Line: The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left.The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver.Despite the treatment with antifungal agents, she died from cardiac tamponade after three months.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

ABSTRACT
We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.

No MeSH data available.


Related in: MedlinePlus