Betancourt Blas Y, Garofoli Adrian C, Sandhu Jagbir S, Boma Noella, Sy Alexander M
Department of Medicine, Metropolitan Hospital Center, New York and New York Medical College, Valhalla, New York, USA.
Department of Pathology, Metropolitan Hospital Center, New York and New York Medical College, Valhalla, New York, USA.
BMJ Case Rep. 2015 Jul 7;2015:bcr2015211249. doi: 10.1136/bcr-2015-211249.
Pulmonary aspergillosis presents with a variety of clinical forms including invasive pulmonary aspergillosis, chronic necrotising aspergillosis, aspergilloma, chronic cavitary pulmonary aspergillosis and allergic bronchopulmonary aspergillosis. Haemoptysis is a devastating complication of pulmonary aspergillosis and a common indication for surgery. We report a case of a 54-year-old man with a history of pulmonary tuberculosis and diabetes mellitus, who presented with productive cough and haemoptysis for 2 months. Chest CT revealed a 30 mm diameter soft tissue mass in the upper lobe of the right lung. Haemoptysis subsided with conservative measures, but 2 weeks later the patient developed a new episode of persistent haemoptysis, which was only partially controlled with bronchial arterial embolisation. He underwent right upper and middle lobectomy. Histology examination confirmed the presence of a fungal cavitary lesion. The patient was started on voriconazole, and recovered with no recurrence at 18 months follow-up.
肺曲霉病有多种临床类型，包括侵袭性肺曲霉病、慢性坏死性曲霉病、曲菌球、慢性空洞性肺曲霉病和变应性支气管肺曲霉病。咯血是肺曲霉病的一种严重并发症，也是常见的手术指征。我们报告一例54岁男性患者，有肺结核和糖尿病病史，出现咳痰和咯血2个月。胸部CT显示右肺上叶有一个直径30mm的软组织肿块。咯血经保守治疗后缓解，但2周后患者出现新的持续性咯血，支气管动脉栓塞仅部分控制了出血。他接受了右上叶和中叶切除术。组织学检查证实存在真菌性空洞病变。患者开始使用伏立康唑治疗，在18个月的随访中康复且无复发。
