Postsurgical mediastinal aspergilloma masquerading as malignancy

Abstract

A 70-year-old man with non-ischaemic dilated cardiomyopathy presented with symptoms of fatigue, chills and unintentional weight loss over the past 2 months. Initial evaluation revealed anaemia, peripheral leucocytosis and elevated inflammatory markers. Results of an oesophagogastroduodenoscopy, colonoscopy, blood bacterial and fungal cultures and bone marrow biopsy were negative. An F-FDG positron-emission tomography-CT demonstrated an indeterminate, intensely FDG-avid 5 cm × 2 cm × 5.6 cm × 6.7 cm mass centred within the junction of the superior vena cava and right atrium, suggestive of probable malignancy versus an inflammatory thrombus. After multidisciplinary consideration, patient underwent a diagnostic minithoracotomy and a thick fibrotic mediastinal mass was visualised and evacuated. The encapsulated mass contained thick, white creamy liquid that appeared to be purulent/necrotic material. The biopsies of the capsule wall on frozen section demonstrated fungal elements consistent with Aspergillosis species. Fungal culture confirmed diagnosis of.

Aspergillus-related lung mass masquerading as a lung tumour

“…Aspergillosis has been described causing lobar collapse and mimicking late-onset asthma [ 6 ], and it has even been described in the post-cardiac surgery setting presenting as a mediastinal mass requiring surgical intervention [ 7 ]. In the case of Aspergillus -related lung disease causing lobar collapse, the diagnosis was made at bronchoscopy, and although the presentation was atypical, the variant of allergic bronchopulmonary aspergillosis is well described [ 1–2 ].…”

A young immunocompetent female with anterior mediastinal mass

“…There is a report of mediastinal infection in a postcardiac surgery patient mimicking a mass due to Aspergillus infection. [ 19 ] The infection may be associated with non-specific symptoms and diagnosed incidentally after biopsy or in some cases the fungus may infiltrate the mediastinal structures such as superior vena cava (SVC) leading to the development of SVC syndrome. [ 20 21 ] Most importantly there are no specific radiological features that can pinpoint a diagnosis of mediastinal aspergilloma.…”