Casal Roberto F, Adachi Roberto, Jimenez Carlos A, Sarkiss Mona, Morice Rodolfo C, Eapen Georgie A
Department of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
J Med Case Rep. 2009 Nov 23;3:9290. doi: 10.1186/1752-1947-3-9290.
Invasive pulmonary aspergillosis is the most common form of infection by Aspergillus species among immunocompromised patients. Although this infection frequently involves the lung parenchyma, it is unusual to find it limited to the tracheobronchial tree, a condition known as invasive aspergillus tracheobronchitis.
A 65 year-old Hispanic man from Bolivia with a history of chronic lymphocytic leukemia developed cough and malaise eight months after having an allogenic stem cell transplant. A computed tomography of the chest revealed an area of diffuse soft tissue thickening around the left main stem bronchus, which was intensely fluorodeoxyglucose-avid on positron emission tomography scanning. An initial bronchoscopic exam revealed circumferential narrowing of the entire left main stem bronchus with necrotic and friable material on the medial wall. Neither aspirates from this necrotic area nor bronchial washing were diagnostic. A second bronchoscopy with endobronchial ultrasound evidenced a soft tissue thickening on the medial aspect of the left main stem bronchus underlying the area of necrosis visible endoluminally. Endobronchial ultrasound-guided transbronchial needle aspiration performed in this area revealed multiple fungal elements suggestive of Aspergillus species.
We describe the first case of invasive aspergillus tracheobronchitis in which the diagnosis was facilitated by the use of endobronchial ultrasound guided trans-bronchial needle aspiration. To the best of our knowledge, we are also presenting the first positron emission tomography scan images of this condition in the literature. We cautiously suggest that endobronchial ultrasound imaging may be a useful tool to evaluate the degree of invasion and the involvement of vascular structures in these patients prior to bronchoscopic manipulation of the affected areas in an effort to avoid potentially fatal hemorrhage.
侵袭性肺曲霉病是免疫功能低下患者中最常见的曲霉属感染形式。虽然这种感染常累及肺实质，但局限于气管支气管树的情况并不常见，这种情况被称为侵袭性曲霉气管支气管炎。
一名来自玻利维亚的65岁西班牙裔男性，有慢性淋巴细胞白血病病史，在进行异基因干细胞移植8个月后出现咳嗽和不适。胸部计算机断层扫描显示左主支气管周围有弥漫性软组织增厚区域，在正电子发射断层扫描中该区域对氟脱氧葡萄糖摄取强烈。初次支气管镜检查显示整个左主支气管周向狭窄，内侧壁有坏死和易碎物质。从这个坏死区域采集的抽吸物和支气管冲洗液均未确诊。第二次支气管镜检查及支气管内超声显示，在腔内可见的坏死区域下方，左主支气管内侧有软组织增厚。在该区域进行支气管内超声引导下经支气管针吸活检，发现多个提示曲霉属的真菌成分。
我们描述了首例侵袭性曲霉气管支气管炎病例，该病例通过支气管内超声引导下经支气管针吸活检得以确诊。据我们所知，我们还首次在文献中展示了这种疾病的正电子发射断层扫描图像。我们谨慎地建议，在对受影响区域进行支气管镜操作之前，支气管内超声成像可能是一种有用的工具，可用于评估这些患者的侵袭程度和血管结构受累情况，以避免潜在的致命性出血。
