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Pathophysiological Implication of Computed Tomography Images of Chronic Pulmonary Aspergillosis
Tsunehiro Ando1, Naobumi Tochigi, Kyoko Gocho
1Department of Infectious Disease, Japanese Red Cross Medical Center.
Abstract:
Chronic pulmonary aspergillosis (CPA) is a refractory disorder that needs long-term antifungal treatment and occasionally results in fatal respiratory failure and hemoptysis. However, the pathological features of the disorder have not been thoroughly delineated. Thirty cases were therefore analyzed clinically and histologically to elucidate the pathophysiology of CPA. The subjects comprised 14 individuals who underwent surgical removal and 16 patients who died. No subject exhibited a severely immunocompromised state. The main symptoms included cough, hemosputum, and dyspnea. Chest computed tomography (CT) findings revealed a cavity, fungus ball, and consolidation and/or ground glass opacity (GGO); 27 serial CT scans showed enlarged consolidation and/or GGO (70%), dilatation of the cavity (26%), and extension to the opposite lung (22%). Histopathological findings revealed a cavity with ulceration, bronchitis, and various degrees of organizing pneumonia (OP) that were correlated with the area of consolidation and GGO on the CT scan. The essential pathophysiology of CPA can be understood as an active state of ulceration of the cavity and/or erosive bronchitis caused by contact with the fungus ball, which may play a significant role in the development of OP. Consequently, OP is thought to reflect respiratory failure that relates to the prognosis of CPA.
Insights
Chronic pulmonary aspergillosis (CPA) involves lung cavity ulceration and bronchitis, leading to organizing pneumonia (OP). This pathophysiology is linked to respiratory failure and impacts CPA prognosis.
Area of Science:
- Pulmonology
- Infectious Diseases
- Pathophysiology
Background:
- Chronic pulmonary aspergillosis (CPA) is a serious lung condition requiring prolonged antifungal therapy.
- CPA can lead to respiratory failure and hemoptysis, but its pathological features are not fully understood.
- Understanding CPA pathophysiology is crucial for improving patient outcomes.
Purpose of the Study:
- To elucidate the pathophysiology of chronic pulmonary aspergillosis (CPA).
- To correlate clinical and histological findings in CPA patients.
- To investigate the role of fungus balls and organizing pneumonia in CPA.
Main Methods:
- Clinical and histological analysis of 30 CPA cases (14 surgical, 16 deceased).
- Review of chest computed tomography (CT) findings, including serial scans.
- Histopathological examination of lung tissue.
Main Results:
- Common symptoms: cough, hemosputum, dyspnea. Patients were not severely immunocompromised.
- CT findings: cavity, fungus ball, consolidation/GGO. Serial CT showed enlarged consolidation/GGO (70%), cavity dilatation (26%), and contralateral spread (22%).
- Histopathology: ulcerated cavities, bronchitis, organizing pneumonia (OP) correlated with CT findings. OP reflects respiratory failure.
Conclusions:
- CPA pathophysiology involves active cavity ulceration and erosive bronchitis due to fungus balls.
- Organizing pneumonia (OP) is a key feature, reflecting respiratory compromise.
- OP development is linked to the prognosis of chronic pulmonary aspergillosis.
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