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 Significant purulent material could not be withdrawn on aspiration as suspected on CECT.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.