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case_images: Contrast-enhanced chest CT of the patient on September 1, 2022. Space-occupying lesion of anterior upper mediastinum is shown. A low-density necrosis area can be seen on enhanced scan, which is separated from the surrounding esophagus. (A) Lung view. (B) Mediastinal view.
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case_images: The contrast-enhanced chest CT examination showed mixed nodules in the anterior segment of the right upper lobe, inflammation of posterior segment, and middle of the right upper lobe and inferior lingual segment of left upper lobe, and mediastinal space-occupying lesions and multiple lymphadenopathy (Figure 1).
case_images: EBUS-TBNA showed (A) extratracheal pressure stenosis and (B) an unspecified echo mass at the 4-6 o'clock position in the 5cm trachea under the glottis.
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case_images: EBUS-TBNA was performed. EBUS-TBNA showed an extratracheal pressure stenosis and unspecified echo mass at the 4-6 o'clock position in the 5cm trachea under the glottis (Figure 2).
case_images: EBUS-TBNA tissue mNGS results in the patient. (A) The mNGS results showed that the coverage of Aspergillus fumigatus was 0.12%. (B) 97.8% of the microbial DNA sequences were Aspergillus fumigatus.
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case_images: The mNGS detected 301 sequences that could be mapped to Aspergillus fumigatus in a total of 28,759,120 sequences, and the coverage was 0.12%, making up 97.80% of the total microbe sequences (Figure 3).
case_images: The histopathology of the mediastinal specimen obtained from the mediastinal mass. Hematoxylin & eosin (H&E) staining showed many neutrophil cell infiltration and Aspergillus hyphae, along with the hyphae with regular septation and branching at a acute angle (black arrows). (A) H&E staining of ultrasound-guided mediastinal mass puncture tissue; (B) H&E staining of EBUS-TBNA tissue; (C and D) Histiocyte smear of EBUS-TBNA tissue.
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case_images: Tissue from EBUS-TBNA mass puncture tissue was sent for pathological examination, and 5 days after receipt of the sample, the histopathological results showed large number of neutrophil cell infiltrations and Aspergillus hyphae (Figure 4), and periodic acid-Schiff (PAS) staining of specimens was positive. Subsequently, the histopathology of ultrasound-guided mediastinal mass puncture tissue results also showed inflammatory cell infiltration and Aspergillus hyphae (Figure 4).