THORACIC Section 4: INFECTION - Fungal Infections

Question 1

Consolidative nodule/mass with a ground glass halo. The halo of ground glass is actually the invasive component.

Answer 1

Halo Sign

Question 2

Diagnosis?

What radiologic signs do you see?

Answer 2

1. Invasive aspergillus
2. Air Crescent Sign

Question 3

Diagnosis?

Radiologic Sign?

Answer 3

Allergic Broncho-Pulmonary Aspergillosis (ABPA)

“Finger-in-glove”

Question 4

Th is is “Always” seen in patients with long-standing Asthma (sometimes CF).

Answer 4

Allergic Broncho-Pulmonary Aspergillosis (ABPA)

Question 5

Classic CT finding of Allergic Broncho-Pulmonary Aspergillosis (ABPA)?

Answer 5

upper lobe central saccular bronchiectasis with mucoid impaction (‘finger-in-glove’).

Question 6

Diagnosis of ABPA requires BOTH

Answer 6

1. Elevated Serum IgE levels OR a positive skin hypersensitive test against the asshole fungus
2. Elevated Total IgE levels > 1000

Question 7

Diagnosis? Sign?

Is this invasive?

Answer 7

Aspergilloma - Fungus Ball ■ Normal immune system
**That ball will move with positional change

The fungus didn’t make the cavity - it found the cavity. It is squatting in an abandoned cavity - like a hobo.

You could be shown a fungus ball, and they want you to call it invasive. Don’t fall for that. This is not the same thing as invasive. Fungus balls can occur in normal people who have a cavity from trauma, or prior infection etc…

Question 8

This aggressive fungal infection almost always occurs in impaired patients (AIDS, Steroids, Bad Diabetics Etc..).

Answer 8

Mucormycosis

Question 9

You think about this when you have an invasion of the mediastinum, pleura, and chest wall.

Answer 9

Mucormycosis