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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 polypoid mass in the left atrium is shown (arrow). The mass shifted to the mitral valve during the diastolic phase in two apical chamber views (A: diastolic phase, B: systolic phase) of echocardiogram. The mediastinal mass (arrowheads) increased more and compressed the right atrium and the right ventricle in the parasternal short asix view (C) and the two apical chamber views (D) of echocardiogram. LA: left atrium; LV: left ventricle; MV: mitral valve; RA: right atrium; RV: right ventricle.
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Figure 7: The polypoid mass in the left atrium is shown (arrow). The mass shifted to the mitral valve during the diastolic phase in two apical chamber views (A: diastolic phase, B: systolic phase) of echocardiogram. The mediastinal mass (arrowheads) increased more and compressed the right atrium and the right ventricle in the parasternal short asix view (C) and the two apical chamber views (D) of echocardiogram. LA: left atrium; LV: left ventricle; MV: mitral valve; RA: right atrium; RV: right ventricle.

Mentions: One week later, her dyspnea got worsened. The laboratory test showed thrombocytopenia of the platelet cell count of 26,000/µL. The body temperature was 36.5℃, blood pressure 90/60 mm Hg, and pulse rate 130 beats per minute. A CT scan showed that the amount of pleural effusion and pericardial fluid increased more. The mediastinal mass increased in size and still compressed the heart, and the heart was deviated to the left side (Figure 6). The echocardiography observed increased polypoid lesion in the left atrium, and the lesion shifted to mitral valve during the diastolic phase (Figure 7). A pericardiocentesis with drainage was performed to relieve cardiac tamponade. Despite the medical treatment, she wasn't improved. When the patient and her family refused to receive any more intensive cares, she died seven days later. An autopsy was also refused.


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 polypoid mass in the left atrium is shown (arrow). The mass shifted to the mitral valve during the diastolic phase in two apical chamber views (A: diastolic phase, B: systolic phase) of echocardiogram. The mediastinal mass (arrowheads) increased more and compressed the right atrium and the right ventricle in the parasternal short asix view (C) and the two apical chamber views (D) of echocardiogram. LA: left atrium; LV: left ventricle; MV: mitral valve; RA: right atrium; RV: right ventricle.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: The polypoid mass in the left atrium is shown (arrow). The mass shifted to the mitral valve during the diastolic phase in two apical chamber views (A: diastolic phase, B: systolic phase) of echocardiogram. The mediastinal mass (arrowheads) increased more and compressed the right atrium and the right ventricle in the parasternal short asix view (C) and the two apical chamber views (D) of echocardiogram. LA: left atrium; LV: left ventricle; MV: mitral valve; RA: right atrium; RV: right ventricle.
Mentions: One week later, her dyspnea got worsened. The laboratory test showed thrombocytopenia of the platelet cell count of 26,000/µL. The body temperature was 36.5℃, blood pressure 90/60 mm Hg, and pulse rate 130 beats per minute. A CT scan showed that the amount of pleural effusion and pericardial fluid increased more. The mediastinal mass increased in size and still compressed the heart, and the heart was deviated to the left side (Figure 6). The echocardiography observed increased polypoid lesion in the left atrium, and the lesion shifted to mitral valve during the diastolic phase (Figure 7). A pericardiocentesis with drainage was performed to relieve cardiac tamponade. Despite the medical treatment, she wasn't improved. When the patient and her family refused to receive any more intensive cares, she died seven days later. An autopsy was also refused.

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