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Chapter 27 : Histology and Radiology

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Histology and Radiology, Page 1 of 2

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Abstract:

This chapter discusses the pathology of the three major categories of pulmonary aspergillosis (invasive, allergic, and saprophytic) and the diagnostic imaging challenges they pose. The characteristic delayed (or transition) lesion of angio-invasive pulmonary aspergillosis occurs after partial recovery of neutrophil function, by which time the discrete nodule has begun to develop liquefaction necrosis limited to its periphery. Chronic IPA (CPA) is a incompletely understood, indolent but progressive Aspergillus infection that occurs in preformed or new cysts (or cavities). Allergic bronchopulmonary aspergillosis (ABPA) is the archetype of allergic aspergillosis. The clinical constellation of ABPA consists of chronic asthma, mucus production, and elevated serum antigen levels of Aspergillus fumigatus. Importantly, the asthmatic component and continuing lung damage are usually responsive to corticosteroid therapy. Corticosteroid-responsive ABPA-related asthma needs to be differentiated from simple chronic asthma. When patients with simple chronic asthma have bronchiectasis, it is usually of a mild variety and limited to the cylindrical type, i.e., bronchiectasis with parallel nontapering walls rather than with frank dilatation. Simple aspergilloma, or fungus ball, is the most common form of aspergillosis that is detected with imaging studies. A. fumigatus causes a wide variety of pulmonary diseases that result in significant morbidity and mortality. The clinical milieu helps identify the prior probability of such disease while the histopathology is predictive of the imaging findings.

Citation: Greene R, Shibuya K, Ando T. 2009. Histology and Radiology, p 353-362. In Latgé J, Steinbach W (ed), and Aspergillosis. ASM Press, Washington, DC. doi: 10.1128/9781555815523.ch27
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Figures

Image of Figure 1.
Figure 1.

Histopathology of a discrete nodule in IPA. A sharply demarcated nodule (*) surrounded by hemorrhage (arrow) in a whole-lung section of a patient with angio-invasive aspergillosis.

Citation: Greene R, Shibuya K, Ando T. 2009. Histology and Radiology, p 353-362. In Latgé J, Steinbach W (ed), and Aspergillosis. ASM Press, Washington, DC. doi: 10.1128/9781555815523.ch27
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Image of Figure 2.
Figure 2.

CT halo sign in IPA. The CT image of the lung demonstrates a halo sign in a patient with IPA and underlying hematological malignancy. The sign consists of two parts: first, a solid soft tissue macro-nodular core (≥1 cm) through which no pulmonary parenchyma is visible (*), and second, a ground-glass perimeter of intermediate density (arrows) through which the pulmonary parenchyma is still visible. Image obtained from Greene et al. (2007) with permission of the publisher.

Citation: Greene R, Shibuya K, Ando T. 2009. Histology and Radiology, p 353-362. In Latgé J, Steinbach W (ed), and Aspergillosis. ASM Press, Washington, DC. doi: 10.1128/9781555815523.ch27
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Image of Figure 3.
Figure 3.

Time to death for patients under treatment for IPA who had a halo sign at presentation (n = 143) or without a halo sign at presentation (n = 79). Reprinted from Greene et al. (2007) with permission of the publisher.

Citation: Greene R, Shibuya K, Ando T. 2009. Histology and Radiology, p 353-362. In Latgé J, Steinbach W (ed), and Aspergillosis. ASM Press, Washington, DC. doi: 10.1128/9781555815523.ch27
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Image of Figure 4.
Figure 4.

CT air crescent sign in IPA. The CT image demonstrates an air crescent sign in a patient with angio-invasive pulmonary aspergillosis and underlying hematological malignancy. A crescent of air (arrows) surmounts a soft tissue mound of a macronodule (*).

Citation: Greene R, Shibuya K, Ando T. 2009. Histology and Radiology, p 353-362. In Latgé J, Steinbach W (ed), and Aspergillosis. ASM Press, Washington, DC. doi: 10.1128/9781555815523.ch27
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Image of Figure 5.
Figure 5.

Peribronchovascular CT opacities in airway IPA. The CT image demonstrates a peribronchovascular opacity highlighting branching air bronchograms. There are also small branching bronchiolar opacities in the unconsolidated lung (arrows).

Citation: Greene R, Shibuya K, Ando T. 2009. Histology and Radiology, p 353-362. In Latgé J, Steinbach W (ed), and Aspergillosis. ASM Press, Washington, DC. doi: 10.1128/9781555815523.ch27
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Image of Figure 6.
Figure 6.

Illustration of CPA. A liquid-filled preexisting cavity (*) from which Aspergillus sp. was consistently recovered is shown. Pericystic lung opacities and new pleural thickening developed in the right upper lobe (arrows).

Citation: Greene R, Shibuya K, Ando T. 2009. Histology and Radiology, p 353-362. In Latgé J, Steinbach W (ed), and Aspergillosis. ASM Press, Washington, DC. doi: 10.1128/9781555815523.ch27
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Image of Figure 7.
Figure 7.

Imaging of ABPA. CT scan in an asthmatic patient with ABPA. There are multiple branching cystic spaces (*) characteristic of central bronchiectasis.

Citation: Greene R, Shibuya K, Ando T. 2009. Histology and Radiology, p 353-362. In Latgé J, Steinbach W (ed), and Aspergillosis. ASM Press, Washington, DC. doi: 10.1128/9781555815523.ch27
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Image of Figure 8.
Figure 8.

Image of an aspergilloma. A CT scan section demonstrates a fungus ball (*) residing within a preexisting cavity of an asymptomatic patient. The configuration simulates the air crescent sign of angio-invasive aspergillosis.

Citation: Greene R, Shibuya K, Ando T. 2009. Histology and Radiology, p 353-362. In Latgé J, Steinbach W (ed), and Aspergillosis. ASM Press, Washington, DC. doi: 10.1128/9781555815523.ch27
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