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Postsurgical mediastinal aspergilloma masquerading as malignancy.

Saira Farid1, Omar AbuSaleh1, Nana Aburjania1

  • 1Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.

BMJ Case Reports
|August 9, 2017
PubMed
Summary
This summary is machine-generated.

A rare case of Aspergillus fumigatus infection presenting as a mediastinal mass in an immunocompetent patient is described. This fungal infection mimicked malignancy, highlighting the importance of considering infectious causes in complex cases.

Keywords:
cardiothoracic surgeryinfectious diseases

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Area of Science:

  • Cardiology
  • Infectious Diseases
  • Radiology

Background:

  • A 70-year-old male with non-ischaemic dilated cardiomyopathy presented with constitutional symptoms.
  • Initial investigations revealed anemia, leukocytosis, and elevated inflammatory markers, with negative standard microbiological workup.

Observation:

  • 18F-FDG PET-CT identified an intensely avid mass at the superior vena cava-right atrial junction, raising suspicion for malignancy or inflammatory thrombus.
  • A diagnostic minithoracotomy revealed a fibrotic mediastinal mass with purulent material.

Findings:

  • Histopathological examination of the mass capsule demonstrated fungal elements consistent with Aspergillosis.
  • Fungal cultures confirmed the presence of *Aspergillus fumigatus*.

Implications:

  • This case underscores the importance of considering fungal infections, specifically Aspergillosis, in the differential diagnosis of mediastinal masses, even in immunocompetent individuals.
  • The findings highlight the utility of 18F-FDG PET-CT in identifying infectious etiologies that can mimic malignancy.
  • Early diagnosis and appropriate antifungal treatment are crucial for managing such rare presentations of invasive fungal disease.