kidney

Aspergillomas

CT scan at the level of the aortic arch shows a mass in the anterior segment of the right upper lobe of the lung characterised by a c shaped or crescent shaped anterior rim of air with ball of soft tissue, reminiscent of the crescent sign most characteristic of an aspergillus infection of a cavity and resulting in an aspergilloma.
Ashley Davidoff TheCommonVein.net
Aspergilloma – CT Air Crescent Sign Changing Position with Patient Positioning
CT scan in the axial projection with the patient in the supine position shows a soft tissue mass in the right upper lung field with an anterior crescent shaped rim of air (blue arrowheads) anterior to the aspergillus fungus ball (a, magnified in b) 
Since the fungus ball is movable, when the patient is placed in the the left decubitus position c and d), the  fungus ball “sinks” to the dependent position and the air moves to the most superior position (blue arrowheads)
Ashley Davidoff TheCommonVein.net 78612a L
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 
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 scan at the level of the right pulmonary artery shows a mass in the superior segment of the left lower lobe characterised by a c shaped or crescent shaped anterior rim of air with ball of soft tissue, reminiscent of the crescent sign most characteristic of an aspergillus infection of a cavity and resulting in an aspergilloma.
Ashley Davidoff MD
CT scan at the level of the right pulmonary artery shows a mass in the superior segment of the left lower lobe characterised by a c shaped or crescent shaped anterior rim of air with ball of soft tissue with calcification, reminiscent of the crescent sign most characteristic of an aspergillus infection of a cavity and resulting in an aspergilloma.
Ashley Davidoff MD

ABPA Segmental Subsegmental and Small Airway Disease

 

Invasive bronchiolar aspergillosis in a patient who underwent bone marrow transplantation. (a) High-resolution CT scan (lung window) shows peripheral branching structures (arrow) associated with focal areas of consolidation in the right lower lobe. (b) Corresponding photograph of the autopsy specimen shows multiple yellowish acinar nodules (arrows). (c) Photomicrograph (original magnification, ×250; periodic acid?Schiff stain) of a lung biopsy specimen shows complete destruction of the bronchiolar wall (arrowheads) by Aspergillus organisms (arrow).
Rossi, SE et al Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview RadioGraphicsVol. 25, No. 3 2005

 

ABPA – Dominant Segmental and Subsegmental Airway Disease
Allergic Bronchopulmonary Aspergillosis
47114c01 bronchi lungs fx dilated enlarged impacted with sft tissue finger in glove dx allergic bronchopulomonary aspergillosis ABPA aspergillus dx infection inflammation CTscan Davidoff MD

ABPA – Dominant Small Airway Disease

Bronchopneumonic Form of Aspergillosis
43 year old man with known aspergillus infection. Note the thickening of the walls of the segmental subsegmental and small airways with extensive tree in bud changes and bronchial wall thickening. There are centrilobular nodules indicating the small airway disease
Ashley Davidoff MD TheCommonVein.net
117816c

Lower Lobe Bronchiectasis and ABPA over 9 years

Lower Lobe Bronchiectasis and ABPA over 9 years
54 year old female with history of asthma, bronchitis, bronchiectasis, ABPA
CT scan  shows initial CT (a) of the lower lobes and part of the middle lobe performed 9 years prior with  extensive segmental, fluid/soft tissue filled  bronchiectasis within the right lower and to lesser extent the left lower lobe reminiscent of finger in glove morphology.  Subsequent imaging 2 (b),5 (c) and 9 years(d),  reveals ongoing bronchiectasis  (teal arrowhead) subsegmental airway thickening (red arrowhead) and ground glass micronodules indicating small airway disease.   The middle lobe was also involved- not shown here.
Ashley Davidoff TheCommonVein.net

ABPA  with Atelectasis

CXR  Allergic Bronchopulmonary Aspergillosis (ABPA) with Right Upper Lobe Atelectasis
50 year old female with a history of asthma represents with productive cough. CXR in the PA projection (a magnified in b)  shows an ill defined density in the right upper lobe of the lung (orange asterisk) and a relatively lucent right apex (blue asterisk) with  only minimal elevation of the right hemidiaphragm and minimal rightward mediastinal deviation .  The lateral CXR shows a poorly defined density of the atelectatic RUL (orange asterisks c and D) filling in the retrosternal air space, with the hyperinflated right lower lobe reaching the right apex (orange asterisks c and d) .  The significantly hyperinflated right lower lobe likely reduces the overall  volume loss and hence the subtle compensatory changes of the elevated right hemidiaphragm and the mediastinal shift. 
Ashley Davidoff MD TheCommonVein.net
CT  Atelectasis Hyperinflation and Bronchiectasis
ABPA 
The coronal image is relatively anterior and hence presents as a dense consolidation of atelectasis (orange asterisk, a) In the axial images the hyperinflated RLL is seen posteriorly (teal asterisks in b and c)  The region of varicose bronchiectasis is noted posteriorly (lime green arrow, c)  When the net density of these 3 findings (consolidation, hyperinflated RLL and bronchiectasis in the LUL) are superimposed on CXR they present with a difficult interpretation since it is the overall net density that gets reflected.  The CT scan helps us understand the findings
Ashley Davidoff MD TheCommonVein.net

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.ne

ABPA and TB

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

ABPA and Pneumonia

Bronchopneumonic Form of Aspergillosis
Note a subsegmental consolidation in the anterior segment of the left upper lobe in a 43 year old man with known aspergillus infection. Note the thickening of the walls of the segmental subsegmental and small airways with bronchiectasis and bronchiolectasis. There are centrilobular nodules indicating the small airway disease
Ashley Davidoff MD TheCommonVein.net 117811c

Invasive Aspergillosis

CT Scan Large Infiltrate with Reversed Halo Sign
The coronal CT scan  shows a rapidly progressive interstitial infiltrate in the left upper lobe with a focal subsegmental infiltrate in the right lower lobe, both showing features of a reversed halo sign (Atoll sign)  There is evidence of bronchial wall thickening.
Diagnosis Aspergillus Infection
Ashley Davidoff TheCommonVein.net
CT Scan Large Infiltrate with Reversed Halo Sign
The coronal CT scan  shows a rapidly progressive interstitial infiltrate in the left upper lobe with a focal subsegmental infiltrate in the right lower lobe, both showing features of a reversed halo sign (Atoll sign)  There is evidence of bronchial wall thickening.
Diagnosis Aspergillus Infection
Ashley Davidoff TheCommonVein.net
Consolidative Changes in the Lung Bases with Obstruction of the Lower Lobe Airways
The sagittal CT scan  shows a rapidly progressive interstitial infiltrate in the left upper and lower lobes showing features of a reversed halo sign (Atoll sign)  There is evidence of basilar consolidation   Extensive disease of the segmental and subsegmental airways is noted (red arrow)  Fungal Hyphae were identified at bronchoscopy
Diagnosis Aspergillus Infection 
Ashley Davidoff TheCommonVein.net

 

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