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اسبيرجيلوما Aspirgilloma


اسبيرجيلوما Aspirgilloma

اسبيرجيلوما Aspirgilloma

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Aspergillus fumigatus and Aspergillus flavus are the most common species responsible for pulmonary aspergilloma.
Overwhelming exposure to spores and, in most cases, preexisting pulmonary cavitary disease are needed for aspergilloma to progress, often in the upper lung fields.

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A patient can develop a single lesion or multiple lesions of varying sizes

in one or in both lungs. Bilateral involvement is only seen in about 5% to 10% of the cases.6 Aspergilloma is a noninvasive form of aspergillosis. However, semi-invasive aspergillosis, in which Aspergillus develops its own cavity, without invading the surrounding tissues, may occur in a patient with a mildly depressed immune system,7 such as in the case of COPD

Although aspergilloma can be asymptomatic, many patients present with a combination of signs and symptoms that include:
* Cough
* Blood-tinged sputum
* Clubbing
* Malaise
* Weight loss
* Chest pain
* Indeterminate nodule.

Other forms of pulmonary aspergillosis include acute inhalational Aspergillus pneumonia, invasive pulmonary aspergillosis, and allergic bronchopulmonary aspergillosis.

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Diagnosis

The clinical diagnosis of pulmonary aspergilloma is made by the combination of a hemoptysis presentation and a radiographic demonstration of an intracavitary mass. A chest radiograph or a CT scan will reveal an upper lobe or apical opaque round mass, surrounded by a cavity resembling an "air crescent" or a "meniscus" sign, with adjacent pleural thickening

Laboratory studies using double immunodiffusion tests will show a high number of precipitins, which are present in 92% to 100% of patients with aspergilloma; and enzyme-linked immunosorbent assay will show high immunoglobulin G antibody titers.

Pathologically, microscopic examination reveals uniform hyphae ranging from 3 to 6 µm in width, regularly septate, with parallel contours and acute-angle branching from the parent hyphae. The branching is progressive and dichotomous. Viable hyphae are basophilic and are therefore best visualized with Grocott-Gomori methenamine–silver nitrate stain . In contrast, necrotic hyphae are hyaline or eosinophilic.9,10 Conidiophores originate from the basal (also known as foot) cell located
on the supporting hyphae and terminate in a vesicle at the apex

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