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Long-term follow-up: tuberculosis, bronchiectasis and chronic pulmonary aspergillosis

Oxana Munteanu

Oxana Munteanu

Department of Internal Medicine, Division of Pneumology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”Chisinau,
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Munteanu, Oxana
, 
Dumitru Chesov

Dumitru Chesov

  • Department of Internal Medicine, Division of Pneumology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”Chisinau,
  • Department of Clinical Infectious Diseases, Research Center BorstelGermany
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Chesov, Dumitru
, 
Doina Rusu

Doina Rusu

  • Department of Internal Medicine, Division of Pneumology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”Chisinau,
  • Department of Pneumology, Phthisiopneumology Institute “Chiril Draganiuc”Chisinau,
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Rusu, Doina
, 
Irina Volosciuc

Irina Volosciuc

Department of Internal Medicine, Division of Pneumology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”Chisinau,
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Volosciuc, Irina
 et 
Victor Botnaru

Victor Botnaru

Department of Internal Medicine, Division of Pneumology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”Chisinau,
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Botnaru, Victor
  
09 déc. 2019
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Publié en ligne: 09 déc. 2019
Pages: 138 - 143
DOI: https://doi.org/10.2478/pneum-2019-0040
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© 2019 Oxana Munteanu et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

(A) Cachectic aspect of the patient. (B) Greenish colour of sputum suggestive of Pseudomonas aeruginosa infection. (C)P. aeruginosa colonies growing on blood agar. The colonies are spreading and flat with serrated edges and metallic sheen; in areas of confluent growth, the colonies and agar are dark due to production of the pigments pyoverdine and pyocyanin.
(A) Cachectic aspect of the patient. (B) Greenish colour of sputum suggestive of Pseudomonas aeruginosa infection. (C)P. aeruginosa colonies growing on blood agar. The colonies are spreading and flat with serrated edges and metallic sheen; in areas of confluent growth, the colonies and agar are dark due to production of the pigments pyoverdine and pyocyanin.

Figure 2

(A) Chest radiograph during the episode of TB relapse (22 August 2002) showing a cavitary lesion in the upper right lobe (arrows) and multiple nodular opacities (suggestive of mucoid bronchial impaction), circular opacities (arrowheads) and the tram-track appearance of bronchial walls, with paired parallel linear opacities radiating from the hilum of both lungs, more prominent in the right inferior area. Note “rosette” images in the left perihilar area (arrowheads). The right hemidiaphragm, costophrenic angle and cardiac silhouette are obscured due to fibrotic lesions. (B) Chest radiograph after 1 year of treatment for PTB showing persistence of previous pulmonary lesions and a small improvement of peribronchial cuffing. (C) A 9 years later chest radiograph (26 January 2012) reveals extensive fibrosis, reduced size of the right lung and progression of the bronchiectasis (arrowheads) with upward hilar traction. A possible fungus ball with the air-crescent sign could be supposed inside the cavitary lesion (arrows). (D, E) 12 years later (24 August 2016), frontal and lateral view of chest radiography showing reduced upper lobe volume with an important thickening of the pleura and a single lung cavity with thick walls and completely destroyed right upper lobe. Progression of varicose and cystic bronchiectasis (some of them with air-fluid level – arrowheads) in both lungs; right sight traction and dilatation of the trachea were identified. Associated signs of hyperinflation could be seen; there are marked flattening of the hemidiaphragms (more evident on the lateral view) and widening of the retrosternal clear space.
(A) Chest radiograph during the episode of TB relapse (22 August 2002) showing a cavitary lesion in the upper right lobe (arrows) and multiple nodular opacities (suggestive of mucoid bronchial impaction), circular opacities (arrowheads) and the tram-track appearance of bronchial walls, with paired parallel linear opacities radiating from the hilum of both lungs, more prominent in the right inferior area. Note “rosette” images in the left perihilar area (arrowheads). The right hemidiaphragm, costophrenic angle and cardiac silhouette are obscured due to fibrotic lesions. (B) Chest radiograph after 1 year of treatment for PTB showing persistence of previous pulmonary lesions and a small improvement of peribronchial cuffing. (C) A 9 years later chest radiograph (26 January 2012) reveals extensive fibrosis, reduced size of the right lung and progression of the bronchiectasis (arrowheads) with upward hilar traction. A possible fungus ball with the air-crescent sign could be supposed inside the cavitary lesion (arrows). (D, E) 12 years later (24 August 2016), frontal and lateral view of chest radiography showing reduced upper lobe volume with an important thickening of the pleura and a single lung cavity with thick walls and completely destroyed right upper lobe. Progression of varicose and cystic bronchiectasis (some of them with air-fluid level – arrowheads) in both lungs; right sight traction and dilatation of the trachea were identified. Associated signs of hyperinflation could be seen; there are marked flattening of the hemidiaphragms (more evident on the lateral view) and widening of the retrosternal clear space.

Figure 3

HRCT, lung window, prone position, five transversal images at different anatomical levels and coronal reconstruction (October 2016) demonstrating the spread of bronchiectasis (tubular, varicose and cystic) in all lobes and multiple large, irregular, thick-walled cavities with intracavitary masses (fungus ball) and pleural thickening. The mass is with air-crescent sign but no fluid level. Note tracheal enlargement and a tracheal diverticulum. (B, D) HRCT images taken 18 months later, patient being without any antifungal treatment. Transversal sections and coronal reconstruction at the same anatomical levels as in 2016 showing completely destroyed right upper lobe, an increase in size of the cavities and pleural thickness. New areas of consolidation close to cavitary lesions were observed and no intracavitary masses. Both lungs show distortion features, severe cystic bronchiectasis and progression of the disease.
HRCT, lung window, prone position, five transversal images at different anatomical levels and coronal reconstruction (October 2016) demonstrating the spread of bronchiectasis (tubular, varicose and cystic) in all lobes and multiple large, irregular, thick-walled cavities with intracavitary masses (fungus ball) and pleural thickening. The mass is with air-crescent sign but no fluid level. Note tracheal enlargement and a tracheal diverticulum. (B, D) HRCT images taken 18 months later, patient being without any antifungal treatment. Transversal sections and coronal reconstruction at the same anatomical levels as in 2016 showing completely destroyed right upper lobe, an increase in size of the cavities and pleural thickness. New areas of consolidation close to cavitary lesions were observed and no intracavitary masses. Both lungs show distortion features, severe cystic bronchiectasis and progression of the disease.

Figure 4

Positive lateral flow assay for A. fumigatus (LDBio Diagnostic, France).
Positive lateral flow assay for A. fumigatus (LDBio Diagnostic, France).
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Sujets de la revue:
Médecine, Médecine clinique, Médecine clinique, autres, Médecine interne, Pneumologie
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