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presentation of aspergillosis&#44;<a href="&#35;bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> characterized by the growth of <span class="elsevierStyleItalic">Aspergillus</span> species into the bronchial lumen&#46; These two different presentations of aspergillosis can co-exist in the same patient&#46; The endobronchial aspergilloma is a non invasive form of aspergillosis&#44; and in many cases incidentally diagnosed&#44; in a patient who had undergone a bronchoscopy to investigate haemoptysis&#44; or for another reason&#46;</p><p class="elsevierStylePara">A 64-year-old male outpatient was referred for bonchoscopy because of CT findings of cavitary lesion with a suggestive image of a fungus ball&#44; in the lingular division of the left upper lobe &#40;LUL&#41;&#44; at that time without respiratory complaints&#46; He had a background of congestive heart failure&#44; rheumatoid arthritis treated with methotrexate and high-dose of prednisolone&#44; and a diagnosis of pulmonary tuberculosis 6 months before&#44; still under treatment&#44; with a cavitary lesion in the lingular division&#46; When diagnostic video-bronchoscopy was perfomed&#44; we found a large yellowish hard mass &#40;<a href="&#35;f0005" class="elsevierStyleCrossRefs">Figure 1</a>&#41; with almost complete obstruction of the lower segment of the lingular division of the LUL&#44; and <span class="elsevierStyleItalic">Aspergillus</span> was confirmed by histological examination&#58; small plugs constituted by fungal structures of <span class="elsevierStyleItalic">Aspergillus</span> species after dyeing with PAS and Grocott &#40;<a href="&#35;f0010" class="elsevierStyleCrossRefs">Figure 2</a>&#41;&#46; At the time of diagnosis&#44; the patient&#44; who was immunocompromised&#44; was on treatment for PT&#44; and began treatment with voriconazole&#44; but he died a few months later&#44; from congestive heart failure&#46;</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v22n01-90447953fig1.jpg" alt="Video-bronchoscopy showing a yellowish mass in the lingular division of the LUL&#46;"></img></p><p class="elsevierStylePara">Figure 1&#46; Video-bronchoscopy showing a yellowish mass in the lingular division of the LUL&#46;</p><a name="f0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v22n01-90447953fig2.jpg" alt="Histological examination showing small plugs constituted by fungal structures of &#60;i&#62;Aspergillus&#60;&#47;i&#62; species&#46;"></img></p><p class="elsevierStylePara">Figure 2&#46; Histological examination showing small plugs constituted by fungal structures of <span class="elsevierStyleItalic">Aspergillus</span> species&#46;</p><p class="elsevierStylePara">The endobronchial aspergilloma is a rare entity and was first described by Denning et al&#46; in three patients with AIDS&#44;<a href="&#35;bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> and is usually incidentally detected as a necrotic mass causing bronchial obstruction&#46; It is easily diagnosed by histopathologic examination of the endoscopic biopsies&#44; and should be considered in the differential diagnosis of an endobronchial necrotic lesion&#44;<a href="&#35;bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> in some cases mimicking endobronchial lung cancer&#46; In other cases&#44; superimposed aspergillosis can mask a lung cancer or an endobronchial carcinoid<a href="&#35;bib15" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> and it can be hard to differentiate true EBA with colonization of <span class="elsevierStyleItalic">Aspergillus</span> of an underlying cancer&#46;<a href="&#35;bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> There are also descriptions of endobronchial aspergilloma associated with a foreign body<a href="&#35;bib17" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> or causing a bronchomediastinal fistula&#46;<a href="&#35;bib18" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a> An EBA can occur in immunocompetent patients&#44; with or without underlying lung disease&#44; and because the optimal treatment or duration of therapy has not yet been established&#44; the EBA requires close medical watch&#46; In our case we describe two forms of aspergilloma in the same patient&#44; an EBA and a pulmonary aspergilloma&#44; and in the course of a treatment for PT&#46; This case is more than just a bronchoscopic curiosity&#44; as it helps us to understand the wide variety of pulmonary aspergillosis&#46;</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara">Corresponding author&#46; duartearaujodr&#64;sapo&#46;pt</p>"
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Endobronchial aspergilloma: An unusual presentation of pulmonary aspergillosis
D.. Araújoa,
Corresponding author
duartearaujodr@sapo.pt

Corresponding author. duartearaujodr@sapo.pt
, M.. Figueiredoa, P.. Monteirob
a Respiratory Department, CHAA, Guimarães, Portugal
b Anatomy Department, CHAA, Guimarães, Portugal
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still under treatment&#44; with a cavitary lesion in the lingular division&#46; When diagnostic video-bronchoscopy was perfomed&#44; we found a large yellowish hard mass &#40;<a href="&#35;f0005" class="elsevierStyleCrossRefs">Figure 1</a>&#41; with almost complete obstruction of the lower segment of the lingular division of the LUL&#44; and <span class="elsevierStyleItalic">Aspergillus</span> was confirmed by histological examination&#58; small plugs constituted by fungal structures of <span class="elsevierStyleItalic">Aspergillus</span> species after dyeing with PAS and Grocott &#40;<a href="&#35;f0010" class="elsevierStyleCrossRefs">Figure 2</a>&#41;&#46; At the time of diagnosis&#44; the patient&#44; who was immunocompromised&#44; was on treatment for PT&#44; and began treatment with voriconazole&#44; but he died a few months later&#44; from congestive heart failure&#46;</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v22n01-90447953fig1.jpg" alt="Video-bronchoscopy showing a yellowish mass in the lingular division of the LUL&#46;"></img></p><p class="elsevierStylePara">Figure 1&#46; Video-bronchoscopy showing a yellowish mass in the lingular division of the LUL&#46;</p><a name="f0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v22n01-90447953fig2.jpg" alt="Histological examination showing small plugs constituted by fungal structures of &#60;i&#62;Aspergillus&#60;&#47;i&#62; species&#46;"></img></p><p class="elsevierStylePara">Figure 2&#46; Histological examination showing small plugs constituted by fungal structures of <span class="elsevierStyleItalic">Aspergillus</span> species&#46;</p><p class="elsevierStylePara">The endobronchial aspergilloma is a rare entity and was first described by Denning et al&#46; in three patients with AIDS&#44;<a href="&#35;bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> and is usually incidentally detected as a necrotic mass causing bronchial obstruction&#46; It is easily diagnosed by histopathologic examination of the endoscopic biopsies&#44; and should be considered in the differential diagnosis of an endobronchial necrotic lesion&#44;<a href="&#35;bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> in some cases mimicking endobronchial lung cancer&#46; In other cases&#44; superimposed aspergillosis can mask a lung cancer or an endobronchial carcinoid<a href="&#35;bib15" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> and it can be hard to differentiate true EBA with colonization of <span class="elsevierStyleItalic">Aspergillus</span> of an underlying cancer&#46;<a href="&#35;bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> There are also descriptions of endobronchial aspergilloma associated with a foreign body<a href="&#35;bib17" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> or causing a bronchomediastinal fistula&#46;<a href="&#35;bib18" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a> An EBA can occur in immunocompetent patients&#44; with or without underlying lung disease&#44; and because the optimal treatment or duration of therapy has not yet been established&#44; the EBA requires close medical watch&#46; In our case we describe two forms of aspergilloma in the same patient&#44; an EBA and a pulmonary aspergilloma&#44; and in the course of a treatment for PT&#46; This case is more than just a bronchoscopic curiosity&#44; as it helps us to understand the wide variety of pulmonary aspergillosis&#46;</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara">Corresponding author&#46; duartearaujodr&#64;sapo&#46;pt</p>"
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ISSN: 08732159
Original language: English
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