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(C) Coronal T1-weighted MR image following the administration of iv contrast confirms the cystic nature of the mass (lack of enhancement) and better shows the relationship of the lesion with the crus of the left hemidiaphragm (long arrows); note the normal appearance of the right crus of the diaphragm (short arrows). (D) Axial CT image (mediastinal window) shows the fine-needle aspiration procedure (arrows) of the lesion (asterisk).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sara González Castro, Luis Gorospe Sarasúa" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Sara" "apellidos" => "González Castro" ] 1 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624001339?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000008/v1_202408020536/S0300289624001339/v1_202408020536/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Probable Invasive Aspergillosis Causing Massive Subcutaneous Emphysema by Rupturing the Pleura and Forming a Bronchopleural Fistula" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "514" "paginaFinal" => "515" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ertugrul Cakir, Esra Ibis, Erdem Yuzuak" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Ertugrul" "apellidos" => "Cakir" "email" => array:1 [ 0 => "drcakir@outlook.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Esra" "apellidos" => "Ibis" ] 2 => array:2 [ "nombre" => "Erdem" "apellidos" => "Yuzuak" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Giresun University, Faculty of Medicine, Department of Radiology, Giresun, Turkey" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 811 "Ancho" => 3425 "Tamanyo" => 302948 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed tomography of the immunocompromised patient showed diffuse ground-glass densities in both lungs. Red arrows show ground-glass densities, consolidated areas (A). Yellow arrows show pleural rupture. White asterisks indicate the area of subcutaneous emphysema, yellow curved arrow indicate bronchopleural fistula, blue arrowheads indicate different aspergillomas showing the air crescent (B and C).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 36-year-old woman with T-cell lymphoma was hospitalized due to disease progression. During the follow-up of the immunocompromised patient, decreased lung sounds and rhonchi were heard on physical examination. Chest radiography showed cavitary areas in both lungs, and computer tomography (CT) was planned. Air crescent sign was observed, and invasive aspergilloma was suspected. As a result of blood tests for multiple infective agents, elevated galactomannan values were observed in the blood, and it was observed that the increase continued in follow-up values [0.93–1.66–1.74 index value (Ref: 0–0.5)]. The patient was diagnosed of probable invasive aspergilloma due to clinical findings, high galactomannan levels in the blood and air crescent on CT examination.</p><p id="par0010" class="elsevierStylePara elsevierViewall">During the follow-up of the immunosuppressed patient who continued to receive chemotherapy for T-cell lymphoma, decreased saturation values, respiratory distress and hemoptysis were observed. Follow-up CT scan showed diffuse ground-glass densities in both lungs. Red arrows indicate ground-glass densities and consolidated areas (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Yellow arrows indicate pleural rupture, white asterixes indicate massive subcutaneous emphysema, yellow curved arrow indicates bronchopleural fistula, and blue arrowheads indicate different aspergillomas showing air crescent. (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B and C). CT evaluation showed that the large cavitary lesion in the right lung had progressed to the adjacent pleura and ruptured to form a bronchopleural fistula, and the free air in the cavity caused massive subcutaneous emphysema. Invasive aspergilloma progresses very rapidly, especially in immunosuppressed patients.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">It should be kept in mind that giant cavitary aspergilloma lesions may destruct adjacent structures and cause complications such as pneumothorax and subcutaneous emphysema.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">No funding was received for this study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The author declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of Interest" ] 2 => array:1 [ "titulo" => "Reference" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 811 "Ancho" => 3425 "Tamanyo" => 302948 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed tomography of the immunocompromised patient showed diffuse ground-glass densities in both lungs. Red arrows show ground-glass densities, consolidated areas (A). Yellow arrows show pleural rupture. White asterisks indicate the area of subcutaneous emphysema, yellow curved arrow indicate bronchopleural fistula, blue arrowheads indicate different aspergillomas showing the air crescent (B and C).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Reference" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unusual life-threatening pneumothorax complicating a ruptured complex aspergilloma in an immunocompetent patient in Cameroon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.N. Nonga" 1 => "B. Jemea" 2 => "A.O. Pondy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2018/8648732" "Revista" => array:5 [ "tituloSerie" => "Case Rep Surg" "fecha" => "2018" "volumen" => "2018" "paginaInicial" => "8648732" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29666746" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000006000000008/v1_202408020536/S0300289624001315/v1_202408020536/en/main.assets" "Apartado" => array:4 [ "identificador" => "94561" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Clinical Images" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000006000000008/v1_202408020536/S0300289624001315/v1_202408020536/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624001315?idApp=UINPBA00003Z" ]
Journal Information
Vol. 60. Issue 8.
Pages 514-515 (August 2024)
Vol. 60. Issue 8.
Pages 514-515 (August 2024)
Clinical Image
Probable Invasive Aspergillosis Causing Massive Subcutaneous Emphysema by Rupturing the Pleura and Forming a Bronchopleural Fistula
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3256
Ertugrul Cakir
, Esra Ibis, Erdem Yuzuak
Corresponding author
Giresun University, Faculty of Medicine, Department of Radiology, Giresun, Turkey
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