ISSN: 1755-5191

Imaging in Medicine

Tracheobronchial Aspergillosis

Tracheobronchial aspergillosis (TBA) is considered an uncommon clinical form of invasive Aspergillus infection confined to the tracheobronchial tree. This entity occurs most commonly in immunocompromised, neutropenic and AIDS patients. Other forms of pulmonary aspergillosis include: allergic bronchopulmonary aspergillosis, aspergilloma, and semi-invasive and invasive aspergillosis. The immunological state of the host influences the type of aspergillosis presentation. There are three forms of TBA based on clinical and pathological features [1, 2, 3]: • -Obstructive: mucous plugs of Aspergillus spp. are present with extensive inflammation and absence of invasion of the tracheobronchial tree. This is a saprophytic form of infection. • -Ulcerative: focal and ulcerative areas are described with histological invasion of Aspergillus hyphae into the bronchial mucosa and/or cartilage. • -Pseudomembranous: there is extensive involvement of the tracheobronchial tree, with a membranous layer (containing Aspergillus) overlying the mucosa. Tracheobronchial involvement is an uncommon form of invasive pulmonary aspergillosis and is found mainly in immunocompromised individuals such as patients with leukemia and prolonged granulocytopenia due to cytotoxic therapy, organ transplant recipients receiving high-dose corticosteroids, or patients with chronic granulomatous diseases. Rarely, such a pattern can also be seen in immunocompetent persons or can involve atypical sites such as the paranasal sinuses, skin, and the tracheobronchial tree. Occasionally, these patients require a prolonged course of antifungal agents. We report a case of aspergillosis involving the tracheobronchial tree in an immunocompetent young male that presented a diagnostic dilemma. Pseudomembranous: there is extensive involvement of the tracheobronchial tree, with a membranous layer (containing Aspergillus) overlying the mucosa.

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