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Case Reports in Radiology
Volume 2014, Article ID 715073, 4 pages
http://dx.doi.org/10.1155/2014/715073
Case Report

Lobar Collapse and Obliteration of Air Bronchogram Allowing Early Diagnosis of Endobronchial Aspergillus Infection following Hematopoietic Stem Cell Transplantation

1Faculty of Medicine and Dentistry, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
2Department of Radiology, Birmingham Children’s Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK
3PHE Mycology Reference Laboratory, Public Health England Microbiology Services, South West Regional Laboratory Bristol Myrtle Road, Kingsdown, Bristol BS2 8EL, UK
4Department of Thoracic Surgery, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
5Department of Paediatric Haematology, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
6School of Cellular & Molecular Medicine, Faculty of Medical Sciences, University of Bristol, University Walk, Bristol BS8 1TD, UK
7Bone Marrow Transplant Unit, Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK

Received 3 September 2014; Revised 20 November 2014; Accepted 21 November 2014; Published 10 December 2014

Academic Editor: Atsushi Komemushi

Copyright © 2014 Elizabeth Thompson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Endobronchial fungal infection (EBFI) is notoriously difficult to diagnose early since it may present few systemic features and does not cause characteristic parenchymal lesions on lung CT scanning. We report a 9-year-old girl who suffered extended neutropenia following graft failure after haematopoietic stem cell transplantation (HSCT) for severe aplastic anaemia. CT scan prior to retransplantation was normal despite persistent cough but lobar collapse was shown on repeat scan 16 days later. The probable diagnosis of EBFI (later proven on bronchoscopy) was only suspected when subsequent chest X-ray (CXR) demonstrated lack of an air bronchogram in the partially collapsed lung. Early radiological suspicion resulted in multiagent antifungal therapy followed by delayed lobectomy, and led to this being the first reported case of Aspergillus EBFI not to result in respiratory failure.