An autopsy case of "fungus ball" type pulmonary aspergillosis complicated with direct invasion of thoracic aorta and systemic dissemination.

Watanabe Masahide, Hotchi Masao

doi:10.3314/jjmm1960.27.182

An autopsy case of a 58-year-old man with a pulmonary aspergilloma in an old tuberculous cavity of the upper lobe of the left lung, complicated with systemic dissemination due to direct invasion of the thoracic aorta was reported.<br>He had an antecedent history of pulmonary tuberculosis from 20 years prior and had been administered antituberculous drugs. He had pain in the 1st and 2nd toes of right foot in October, 1983, and those sites gradually became necroticc, so he was admitted to the Asama General Hospital on February 2, 1984.<br>On admission, he was ill-nourished and had mild fever. Laboratory exaiminations revealed anemia, leukocytosis and a marked increase of erythrocyte sedimentation rate. In the middle of March, transient hemosputa with left chest pain and fever appeared. Thereafter, ileus occurred due to obstruction of branches of the mesenteric artery, and consequently a wide area of small intestine was resected. After the operation, jaundice appeared and on April 2 he suddenly died of massive hemoptysis.<br>At autopsy, a ruptured aneurysm was found in the thoracic aorta, which was surrounded by abscesses caused by Aspergillus sp. The upper lobe of the left lung had an old tuberculous cavity containing a fungus ball and tightly adhered with mediastinum. In addition, the postero-inferior end of the cavity was attached to the aneurysm so that they partially communicated. Multiple thrombi bearing tangles of Aspergillus mycelia were observed in peripheral arteries to the thoracic aorta, and these were associated with anemic infarcts of the spleen and kidney.<br>It was considered that Aspergillus sp. in the fungus ball directly invaded the aneurysmal wall of the thoracic aorta and then disseminated through the arterial system from this lesion. The patient's death was the result of massive hemoptysis caused by rupture of the aneurysm in the cavity.

An autopsy case of "fungus ball" type pulmonary aspergillosis complicated with direct invasion of thoracic aorta and systemic dissemination.

Bibliographic Information

Description

Journal

Citations (1)*help

Keywords

Details 詳細情報について

Export

Report a problem