CTICasesPulmonary Cavity with Aspergilloma and MAC Infection in COPD
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Imaging findings
Chest radiograph reveals a soft tissue mass within a cavitary lesion in the right upper lobe. CT confirms a chronic cavity containing an aspergilloma, accompanied by severe emphysema. Hypertrophy of intercostal arteries and thickened extrapleural tissues are indicative of chronic inflammation. Mass-like areas of consolidation with calcification are also noted. Biopsy showed necrotizing granulomatous inflammation with positive AFB stain, confirmed as non-tuberculous mycobacteria (presumably MAC) via PCR.
Key takeaways
This case demonstrates the classic presentation of a pulmonary aspergilloma within a pre-existing chronic cavity, common in older men with COPD. The superimposition of a Mycobacterium avium complex (MAC) infection within areas of consolidation further complicates the picture. Differentiation from neoplasm is crucial, often requiring biopsy, which here revealed necrotizing granulomatous inflammation consistent with MAC.
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