Adult ; Aspergillosis ; pathology ; surgery ; Female ; Humans ; Laryngeal Diseases ; microbiology ; pathology ; surgery ; Middle Aged ; Vocal Cords ; pathology

We report a case of Aspergillus terreus discitis which developed in a patient with acute lymphoblastic leukemia following induction chemotherapy. A. terreus was isolated from sputum, one month earlier, but the physician did not consider it significant at the time. Magnetic resonance imaging study showed the involvement of L3-4, L4-5 and L5-S1 intervertebral discs. Etiology was established by means of histology and culturing a surgical specimen of disc materials. Our patient survived after a surgical debridement and amphotericin B administration with a total dose of 2.0 g. Discitis caused by Aspergillus terreus is a very rare event. A. terreus is one of the invasive Aspergillus species. The pathogenetic mechanism is discussed and the literature is reviewed.
Aspergillosis/surgery ; Aspergillosis/pathology ; Aspergillosis/microbiology* ; Aspergillosis/drug therapy ; Aspergillosis/complications ; Aspergillus/isolation & purification ; Aspergillus/classification ; Journal Article ; Discitis/surgery ; Discitis/pathology ; Discitis/microbiology* ; Discitis/drug therapy ; Human ; Intervertebral Disk/surgery ; Intervertebral Disk/pathology ; Intervertebral Disk/microbiology* ; Leukemia, Lymphocytic, Acute/microbiology ; Leukemia, Lymphocytic, Acute/drug therapy ; Leukemia, Lymphocytic, Acute/complications* ; Lumbar Vertebrae/surgery ; Lumbar Vertebrae/pathology ; Lumbar Vertebrae/microbiology*

Aspergillus is a common saprophytic fungi of the human airways and causes a broad spectrum of diseases, ranging from aspergilloma to invasive aspergillosis. There are few reports on mediastinal aspergilloma without any underlying pulmonary disease or immunocompromise. Herein, we report a case of mediastinal aspergilloma that we experienced and treated by thoracoscopic resection and oral antifungal medication.
Aspergillosis ; Aspergillus ; Fungi ; Humans ; Lung Diseases ; Mediastinal Diseases ; Thoracic Surgery, Video-Assisted

OBJECTIVETo summarize the experience of diagnosis and surgical treatment for pulmonary and pleural aspergillosis.

METHODSThe clinical data of cases with pulmonary and pleural aspergillosis were analyzed retrospectively between September 1972 and June 2003. There were 53 cases with pulmonary aspergillosis and 3 cases with pleural aspergillosis. Aspergillus was found preoperatively in 8 patients by sputum culture (5 cases) or needle biopsy of the lung (2 cases) or fibro-bronchoscopic biopsy (1 case). All patients were treated with surgical procedures following X-ray film or CT scan.

RESULTSOf 53 cases with pulmonary aspergillosis, 42 lobectomies, 3 segment-Pneumonectomies, and 8 wedge resections were performed. Of three cases with pleural aspergillosis following eliminating their diseased foci in residual pleural space, two underwent thoracoplasty, one underwent postoperative closed chest drainage for one and an half month with fluconazole injected into residual pleural space repeatedly for 1 month (200 mg/100 ml, 1 time per 2 or 3 days). No operative death and major postoperative complications occurred. None of the patients had recurrent symptoms at follow-up.

CONCLUSIONWe recommend aggressive surgical resection for pulmonary and pleural aspergillosis, and the surgical result is excellent.

Adult ; Aged ; Aspergillosis ; diagnosis ; surgery ; Female ; Humans ; Lung Diseases, Fungal ; diagnosis ; surgery ; Male ; Middle Aged ; Pleurisy ; diagnosis ; surgery ; Pneumonectomy ; methods ; Retrospective Studies ; Thoracoplasty ; Treatment Outcome

We report a case of pseudoaneurysm of the anterior ascending branch of the left pulmonary artery, following a left upper lobectomy for pulmonary aspergillosis, for which we have done an endovascular treatment. This is the first case where complete pseudoaneurysm occlusion was accomplished after a transcatheter intra-aneurysmal N-butyl 2-cyanoacrylate (glue) injection.
Adult ; Aneurysm, False/etiology/*therapy ; Embolization, Therapeutic/adverse effects/*methods ; Enbucrilate/*therapeutic use ; Female ; Humans ; Pneumonectomy/adverse effects ; Postoperative Complications/*therapy ; *Pulmonary Artery ; Pulmonary Aspergillosis/surgery

Isolated fungal soft-tissue infections are uncommon, but may cause severe morbidity or mortality. Aspergillosis infection is rare, but the frequency in increasing over the last two decades. Here, we present a patient with utaneous aspergillosis of his right elbow with unusual clinical and radiological features suggestive of a malignant disease, which remained undiagnosed for an extended period of time. The patient presented with necrotic, black-colored skin ulcerations. We completely removed the skin ulcer with the surrounding erythematous skin lesion, and then we reconstructed the area with thoracodorsal perforator free flap. The biopsy specimen contained septate hyphae with dichotomous branching, which is morphologically consistent with a finding of Aspergillus. After surgery, we initiated antifungal medication therapy with amphotericin B and itraconazole. At the time of follow-up, the elbow with the reconstructed flap had fully healed, and no recurrent disease was found.
Amphotericin B/therapeutic use ; Antifungal Agents/therapeutic use ; Aspergillosis/*therapy ; Biopsy ; Humans ; Itraconazole/therapeutic use ; Male ; Middle Aged ; Skin Diseases/*surgery ; *Surgical Flaps ; Treatment Outcome

BACKGROUND AND OBJECTIVES: Endoscopic paranasal sinus surgery is effective for the treatment of paranasal sinus lesion and reduction of invasiveness enabling the surgeon to perform precise procedures with minimal tissue traumatization. But, some studies showed that there was a risk of invasive management and major complications occurring in 0.5% to 1% of all procedures. The aim of this study was to assess the usefulness and effectiveness of image-guided endoscopic surgery in reducing the complication and treating the disease suitably. SUBJECTS AND METHOD: The image-guided paranasal sinus surgery was performed in 12 patients from 2000 to 2005 who had difficulty in endoscopic surgery for the diagnosis and treatment of the inaccessible location such as skull base, sphenoid and clivus, infratemporal fossa etc. and the uncertain lesion such as severe distorted lesion due to previous sinus operation, congenitally underdeveloped anatomic lesion, nearby vital organ-lesion and submucosal lesion in our experiences. We retrospectively reviewed radiologic evaluations and medical records in our patients. RESULTS: We included 6 oncogenic lesions such as craniopharyngioma, chordoma in clivus and sphenoid sinus, 5 infectious lesions such as invasive aspergillosis and 1 cystic lesion. The accuracy we could achieve varied between 0.9 and 2.0 mm. CSF rhinorrhea occurred in 2 cases after management. But, only one case was not only related to image-guided surgery but also resolved spontaneously. CONCLUSION: Image-guided endoscopic surgery is a safe and effective tool in paranasal sinus and skull base lesion for maximizing surgical results and limiting complications.
Aspergillosis ; Chordoma ; Cranial Fossa, Posterior ; Craniopharyngioma ; Diagnosis ; Endoscopy ; Humans ; Medical Records ; Paranasal Sinuses ; Retrospective Studies ; Skull Base* ; Skull* ; Sphenoid Sinus ; Surgery, Computer-Assisted*

Adolescent ; Aged ; Aspergillosis ; microbiology ; pathology ; Aspergillus ; isolation & purification ; Brain Diseases ; drug therapy ; microbiology ; pathology ; surgery ; Diabetes Complications ; microbiology ; Diagnosis, Differential ; Female ; Humans ; Male ; Mucorales ; isolation & purification ; Mucormycosis ; drug therapy ; pathology ; surgery ; Nose Diseases ; drug therapy ; microbiology ; pathology ; surgery

Aspergillosis is a rare cause of spondylitis. Moreover, early diagnosis by MR imaging and adequate treatment can prevent the serious complications of fungal infection. To our knowledge, the MR findings of multilevel aspergillus spondylitis in the cervico-thoraco-lumbar spine have not been previously described. Here, we report the MR findings of aspergillus spondylitis involving the cervical, thoracic, and lumbar spine in a liver transplant recipient.
Aspergillosis/*diagnosis ; Aspergillus/isolation & purification ; Bone Transplantation ; Cervical Vertebrae/microbiology/pathology/surgery ; Humans ; *Immunocompromised Host ; Liver Transplantation ; Lumbar Vertebrae/microbiology/pathology/surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Postoperative Complications/diagnosis/microbiology/surgery ; Rare Diseases ; Spondylitis/*microbiology/surgery ; Thoracic Vertebrae/microbiology/pathology/surgery

BACKGROUND: The number of immunocompromised hosts has been increasing steadily and a new pulmonary infiltrate in these patients a potentially lethal condition which needs rapid diagnosis and treatment. In this study we sought to examine the clinical manifestations, radiologic findings, and therapeutic outcomes of pulmonary mycoses presenting as a new pulmonary infilrate in immunocompromised hosts. METHOD: All cases presenting as a new pulmonary infilrate in immunocompromised hosts and confirmed to be pulmonary mycoses by pathologic examination or by positive culture from a sterile site between October of 1996 and April of 1998 were included in the study and their chart and radiologic findings were retrospectively reviewed. RESULTS: In all, 14 cases of pulmonary mycoses from 13 patients(male : female ratio = 8 : 5, median age 47yr) were found. Twelve cases were diagnosed as aspergillosis while two were diagnosed as mucormycosis. Major risk factors for fungal infections were chemotherapy for hematologic malignancy (10 cases) and organ transplant recipients(4 cases). Three cases were receiving empirical amphotericin B at the time of appearance of new lung infiltrates. Cases in the hematogic malignancy group had more prominent symptoms : fever(9/10), cough(6/10), sputum(5/10), dyspnea(4/10), chest pain(5/10). Patients in the organ transplant group had minimal symptoms(p<0.05). On simple chest films, all of the cases presented as single or multiple nodules (6/14) or consolidations(8/14). High resolution computed tomograph showed peri-lesional ground glass opacities(14/14), pleural effusions(5/14), and cavitary changes(7/14). Definitive diagnostic methods were as follows : 10 cases underwent minithoracotomy, 2 underwent video-assisted thoracoscopic surgery, 1 underwent percutaneous needle aspiration and 1 case was diagnosed by culture of abscess fluid. All cases received treatment with amphotericin B with 1 case each being treated with liposomal amphotericin B and itraconazole due to renal toxicity. Lung lesion improved in 12 of 14 patient but 4 patients died before completing therapy. CONCLUSION: When a new lung infiltrate develops presenting either as a nodule or consolidation in a neutropenic patient with hematologic malignancy or in a transplant recipient, you should always consider pulmonary mycoses as one of the differential diagnosis. By performing aggressive work up and early treatment, we may improve prognosis of these patients.
Abscess ; Amphotericin B ; Aspergillosis ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Female ; Fungi ; Glass ; Hematologic Neoplasms ; Humans ; Immunocompromised Host* ; Itraconazole ; Lung ; Mucormycosis ; Mycoses* ; Needles ; Prognosis ; Retrospective Studies ; Risk Factors ; Thoracic Surgery, Video-Assisted ; Thorax ; Transplantation ; Transplants