case_images: PMC11131402_01
case_images: (a) Chest CT shows a mass like high-density shadow in the apical segment of the right upper lung, with a diameter of about 33 mm x 27 mm. Bronchiectasis shadow (see arrow) is seen in the periphery, lobulated change, and thin flake, and patchy exudation shadow is seen around. (b) 'Right upper lung' inflammatory lesion with necrosis, a large number of histiocytes and multinucleated giant cell reaction in the stroma (see arrow), and fungal flora (Hematoxylin-Eosin staining HE x100) in the lumen of the bronchi.
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case_images: Chest computed tomography (CT) showed a mass-like lobulated high-density shadow in the right upper lung segment measuring 33 x 27 mm, with a peripheral bronchiectasis shadow and thin, patchy peripheral exudation shadows [Figure 1(a)]. Pathology showed an inflammatory right upper lung lesion accompanied by necrosis, with many tissue cells and multinucleated giant cell reactions in the stroma, fungi in the bronchial lumens, and reactive hyperplasia of four lymph nodes at the bronchial root accompanied by many dead bacteria-like objects [Figure 1(b)].
case_images: (a) Chest CT: the lower lobe of the left lung is patchy and surrounded by fuzzy flocculent shadow (see arrow). (b) Chest CT: left lower pulmonary nodule with cavity formation with a diameter of about 16 mm x 32 mm (see arrow). (c) 'Left lower lung' mycosis with bronchiectasis, a large number of inflammatory cells and multinucleated giant cell reaction in the lung stroma, and a large number of fungal flora can be seen in the bronchial lumen (see arrow) (HE x100). (d) Hyaline fungal hyphae and acute branching (HE x400).
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case_images: Chest CT showed a mass shadow in the left lower lung surrounded by a fuzzy flocculent shadow [Figure 2(a)]. After 10 days of antibiotic treatment, repeat chest CT showed a left lower lobe nodule with cavity formation [Figure 2(b)]. Pathology showed left lower lung mycosis with bronchiectasis, many inflammatory cells and a multinuclear giant cell reaction in the lung stroma, and many fungi in the bronchial lumen [Figure 2(c)]. After magnification, hyaline hyphae with acute branching can be seen [Figure 2(d)].
case_images: (a) Chest CT: a high-density nodular shadow with a diameter of about 11 mm x 13 mm can be seen in the right upper lung apex, the surface is not smooth, and bronchiectasis shadow can be seen around it (see arrow). (b) The bronchiectasis of the right upper lung is accompanied by fibrosis of surrounding lung tissue, a large number of lymphocytes and plasma cells infiltrate, a large number of foam like tissue cells in the alveolar cavity, and a fungus group (see arrow) in the expanded bronchoalveolar cavity (HE x100).
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case_images: Chest contrast-enhanced CT showed a high-density 11 mm x 13 mm nodule at the right pulmonary apex; its surface was irregular, with a surrounding bronchodilation shadow [Figure 3(a)]. Pathology showed right upper lung bronchiectasis with peripheral lung tissue fibrosis, many infiltrating lymphocytes and plasma cells, many foam-like tissue cells in the alveolar cavity, and fungi in the expanded bronchi cavity [Figure 3(b)].
case_images: (a) Chest CT lung window: a high-density nodule with a diameter of about 11 mm x 13 mm with calcification can be seen in the left upper lung lingula segment, the surface is not bright, and bronchiectasis shadow can be seen around (see arrow). (b) Fungal mass resembling Aspergillus (see arrow) in the lumen of the 'left upper lung tongue' branch, accompanied by inflammatory changes in the surrounding lung tissue and local regional lymphoid tissue hyperplasia (HE x100).
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case_images: Enhanced chest CT showed an 11 mm x 13 mm high-density nodule with calcification in the lingual segment of the right upper lung, with peripheral bronchiectasis [Figure 4(a)]. Pathology showed fungal hyphae in the bronchi of the left upper lung lingual segment accompanied by inflammatory changes in the surrounding lung tissue and local regional lymphoid tissue hyperplasia [Figure 4(b)].
case_images: (a) Chest CT in 2018 shows 8-mm circular translucent shadow with surrounding fibrous strip shadow in the left lower lung (see arrow). (b) 2021-7-30 chest CT: the lower lobe of the left lung is like a circular high transparency shadow, with a size of about 12 mm x 13 mm. There is a nodular shadow protruding into the cavity on the inner wall (see arrow). (c) 'Wedge-shaped specimen of left lower lung' (HE x 100): cystic bronchiectasis, pus in the cystic cavity, containing fungal mass resembling Aspergillus (see arrow), peripheral fibrosis, infiltration of a large number of lymphocytes, plasma cells, and neutrophils, with multinuclear giant cell reaction and lymphoid tissue hyperplasia.
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case_images: Case 5: An otherwise healthy 44-year-old woman underwent chest CT 3 years before admission that showed an 8-mm-diameter cavity shadow in the left lower lung [Figure 5(a)]. One month before admission, chest CT showed a cystic cavity in the lower lobe of the left lung with the formation of medial wall nodules, and the focus was enlarged compared with the previous CT [Figure 5(b)]. The postoperative pathology showed cystic bronchiectasis, pus in the cystic cavity, including fungal hyphae, peripheral fibrosis, and many lymphocytes, plasma cells, and neutrophils, accompanied by multinucleated giant cell reaction and lymphoid tissue hyperplasia [Figure 5(c)].