Case Discussion
A 55 years old female patient came with a chief complaint of cough and
gradual weight loss for about 2 months. She also complained of
difficulty in breathing and hemoptysis occasionally.
Laboratory investigations showed low hemoglobin 10.7gm %, total
leukocyte count of 8,600/cu mm with a differential count of neutrophil
57%, lymphocyte 30%, eosinophils 11% and monocyte 02%. Platelets
were within normal limit. Her HIV, HbsAg and anti HCV tests were non
reactive.
Contrast enhanced computed tomography (CECT) of lung demonstrated well
defined round to oval hypodense lesion with air pockets in right upper
lobe measuring approximately 38.8x27.9x35.1mm. Cavitary lesion with
surrounding consolidation in right lower lobe (Fig 1) was present.
Patchy consolidations with some lesions showing cavitations in left
upper lobe of lung. Surrrounding reticulo-nodular opacities were also
recognized (Fig 2). Multiple enlarged mediastinal nodes were also
notable. Radiological impression was suggestive of pulmonary Koch’s with
lung abscess. Patient was referred for drainage of abscess. Under all
aseptic precautions, local anesthesia and CT guidance 18 gauze spinal
needle was inserted (Fig 3). Significant purulent material could not be
withdrawn on aspiration as suspected on CECT. Hence aspiration was
performed and slides were prepared for cytology.
Fine needle aspiration cytology showed mainly necrotic material with
several clusters and balls of aspergillus (Fig 4) which demonstrated
septate, acute angle branched hyphae mimicking an arborizing tree (Fig
5). Ziehl Neelsen stain for acid fast bacilli was performed which was
negative. Cytological impression was given as aspergilloma of right
lung.