IMAGES IN EMERGENCY MEDICINE
Aspergillosis masquerading as frank haemoptysis
1 Department of General Internal Medicine, Countess of Chester NHS Trust, Chester, UK
2 Department of Acute Medicine/Cardiology, Countess of Chester NHS Trust, Chester, UK; Respiratory Department, Countess of Chester NHS Trust, Chester, UK.
Correspondence to:
Dr R M Cooper, Department of General Internal Medicine, Countess of Chester NHS Trust, Liverpool Road, Chester CH2 1UL, UK; robcooper@doctors.net.uk
| The first 150 words of the full text of this article appear below. |
A 29-year-old man presented to the emergency medicine department with frank haemoptysis. A year ago he had had severe pneumonia, complicated by parapneumonic effusion that progressed to empyema. No organism was identified. Extensive surgical exploration and drainage was performed. He was subsequently found to have a cavity in the left lung. Sputa examination was strongly positive for Aspergillus precipitans. Long-term combination therapy with itraconazole and metronidazole was therefore initiated.
The patient had attended the respiratory outpatient clinic 2 days earlier with symptoms of persistent dry cough. The chest radiograph demonstrated a fluid level within the cavity. On admission he expectorated in a projectile fashion three cupfuls of apparent fresh blood. The only preceding feature was mild left-sided pleuritic pain. Review of the radiograph afterwards revealed an empty cavity. The patient had completely expectorated its contents (fig 1).
Figure 1 Chest radiographs before and after expectoration, taken 2 days apart.
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