case_images: PMC9298875_01
case_images: (A) Chest CT showed left pleural effusion with left atelectasis before admission. (B) On the second day of hospitalization, medical thoracoscopy revealed extensive purulent attachment to the parietal pleura, visceral pleura, and diaphragmatic pleura. (C,D) Show the findings of thoracoscopy on the 7th and 23rd days of hospitalization, respectively. After systemic medication, thoracic irrigation and thoracoscopy to clear necrosis and adhesions, the necrosis in the thoracic cavity gradually decreased, the pleural thickening and adhesion gradually decreased. (E) HE staining showed that chronic inflammatory cells infiltrated and aggregated tissue cells in the fibrous connective tissue. The cytoplasm of tissue cells was rich in powdery staining, and there were clustered, oval and light blue fungal spores (black arrows). PAS staining showed spore capsules in pink (black arrows). Silver staining showed spore capsules in black (black arrows) (Scale bar = 50 mum).
case_images: fpubh-10-914529-g0001.jpg
case_images: PMC9298875_01_fpubh-10-914529-g0001.jpg
case_images: F1
case_images: There was no enlargement of hilar, no enlarged or calcified mediastinal lymph nodes, no widening of mediastinum and no compression of trachea and large blood vessels (Figure 1A). Extensive purulent attachments to the parietal pleura, visceral pleura, and diaphragmatic pleura were observed (Figure 1B). The biopsy special staining results (Figure 1E) were as follows: hexamine silver (+), PAS (+), acid fast (-). The necrosis in the thoracic cavity gradually decreased, the pleural thickening and adhesion gradually decreased (Figures 1B-D), and the left lung gradually re-expanded.
case_images: (A-C) Are respectively the chest CT scans of the patient on the 5th, 14th, and 22nd days of hospitalization, showing the left lung was gradually re-expanded, the left pleural effusion was gradually reduced, and the left pleural thickening was gradually decreased. (D) Chest CT of the patient nearly 1 year after discharge, showing that the left lung recruited, a very small amount of pleural effusion on the left side and slightly thick pleura.
case_images: fpubh-10-914529-g0002.jpg
case_images: PMC9298875_01_fpubh-10-914529-g0002.jpg
case_images: F2
case_images: During hospitalization, the patient underwent three chest CT scans (Figures 2A-C), which revealed that the left lung was gradually re-expanded, the left pleural effusion was gradually reduced, and the left pleural thickening was gradually decreased. The last re-examination of the chest CT about 1 year later, showed that the left lung was re-expanded, with little pleural effusion and pleural thickening on the left side (Figure 2D).