case_images: PMC5120194_01
case_images: View of the trachea during bronchoscopy. Note the obstruction of >50% of the tracheal lumen by whitish thick secretions.
case_images: CRIPE2016-9676234.001.jpg
case_images: PMC5120194_01_CRIPE2016-9676234.001.jpg
case_images: fig1
case_images: An estimated 50-60% of the entire tracheal lumen was filled with thick, whitish secretions, in addition to a mucosal pseudomembrane that was visualized down to the carina (Figure 1).
case_images: View of the carina during bronchoscopy. Note the thick, pseudomembranous white material obstructing a great portion of both mainstem bronchi and the optical foreign body forceps in place used to gently remove these.
case_images: CRIPE2016-9676234.002.jpg
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case_images: fig2
case_images: After mechanical removal of the secretions and pseudomembranes (Figure 2), she was left intubated and readmitted to the intensive care unit for further care.
case_images: Grocott's methenamine silver stain of a piece of pseudomembrane obtained during bronchoalveolar lavage showed dichotomously branched and septate hyphae, suggestive of the diagnosis of Aspergillus. 400-fold magnification.
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case_images: fig3
case_images: Microscopic examination of the debris obtained by bronchoalveolar lavage confirmed fungal elements consistent with Aspergillus fumigatus (Figure 3).
case_images: Autopsy: posterior view of left bronchial tree demonstrating the complete filling of even most distal airways with yellow gelatinous material.
case_images: CRIPE2016-9676234.004.jpg
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case_images: fig4
case_images: The entire bronchial tree was lined with tan-yellow material and all lumen were narrowed or obstructed at the level of the small intrasegmental bronchi (Figures 4 and 5).
case_images: Autopsy: coronal cut through lung demonstrating peribronchial congestion and hemorrhage.
case_images: CRIPE2016-9676234.005.jpg
case_images: PMC5120194_01_CRIPE2016-9676234.005.jpg
case_images: fig5
case_images: The entire bronchial tree was lined with tan-yellow material and all lumen were narrowed or obstructed at the level of the small intrasegmental bronchi (Figures 4 and 5).
case_images: Histopathology: 10-fold magnification and H+E stain of a large bronchus demonstrating an entirely obstructed lumen.
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case_images: PMC5120194_01_CRIPE2016-9676234.006.jpg
case_images: fig6
case_images: There was peribronchial congestion and hemorrhage (Figure 6), as well as hilar and mediastinal lymphadenopathy.