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X-ray Case (8)

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Diagnostic:

This middle aged gentleman had suffered with asthma for many years, but had recently developed worsening symptoms associated with haemoptysis. What abnormalities are seen on the plain chest film?

What is the diagnosis?

Dr.Habiib:
Answer:
The X-ray shows the two lungs which at the hilum of the lung shadowing and dilated and thinking the wall of bronchi.
The is no signs of pneumothorax or pleural effusion.
On other hand there is large cavity in the middle of left lung with consolidation.
The X-ray finding suggests a segment infiltrate.
 As our patient suffered with asthma for many years the most properly is chronic allergic bronchopulmonary aspergillosis with actinomycosis
Inhalant allergens, in patients with allergic asthma, play a key role in bringing about the inflammation present in the airways. Fungi are increasingly being recognized as important inhalant allergens. Among the fungi, Aspergillums, a genus of spore-forming fungi found worldwide, is linked to asthma in more ways than one.  Its spores are inhaled by one and all but in the healthy normal individual, they seldom have any effect. However, in the asthmatic subjects, the fungal spores are trapped in the thick and viscid secretions that are usually present in the airways. This generally develops in atopic subjects and is sustained by continuous inhalation of Aspergillus antigens, triggering asthma. The clinical spectrum of Aspergillus-associated hypersensitivity respiratory disorders include Aspergillus induced asthma, allergic bronchopulmonary aspergillosis (ABPA) and allergic Aspergillus sinusitis (AAS). Hypersensitivity pneumonitis too can be caused by Aspergillums, but this is generally seen in non-atopic individuals.
On other hand actinomycosis is normally present in the oral cavity as commensal which can causes disease in some times with unknowd mechanism.

NB:
For farther analysis we must take samples and  sent into microbiology lab. And same time another sample to the histopathology lab to diagnosis the granulomatous of actinomycosis because most of people mistake to mycetoma which is subcutaneous fungi.

Diagnostic:
Well done, Dr Habiib.

That was impressive diagnosis.

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