ABSTRACT
A 76-year-old woman with history of multiple spinal surgeries was found to have chronic recurrent pleural effusion. Thoracentesis was performed, which showed a clear, "water-like" transudative fluid with a total protein level of 0.2 g/dL, glucose level equivalent to serum (118 mg/dL), low LDH level (76 U/dL), and low nucleated cell count. Given the appearance of the fluid, ß-2-transferrin was checked, which confirmed the presence of cerebrospinal fluid in the pleural space. On the basis of the clinical presentation, pleural fluid analysis, clear appearance of the pleural fluid, and ß-2-transferrin positivity, the patient was diagnosed with duropleural fistula.
Subject(s)
Central Nervous System Diseases/complications , Dura Mater , Fistula/complications , Pleural Diseases/complications , Pleural Effusion/diagnostic imaging , Aged , Cerebrospinal Fluid/chemistry , Exudates and Transudates/chemistry , Female , Humans , Pleural Effusion/etiology , Radiography , Recurrence , Transferrin/metabolismABSTRACT
OBJECTIVE: The purpose of this article is to describe 3 patients each of whom developed a different form of tracheobronchial aspergillosis. METHODS: We describe our clinical experience with 3 patients who developed significant respiratory symptoms secondary to Aspergillus infection. All patients were followed closely until there was resolution of pulmonary problems or they succumbed to respiratory insufficiency. RESULTS: The first patient had asthma and her clinical and bronchoscopic findings were compatible with the diagnosis of mucoid impaction syndrome caused by Aspergillus. Response to therapy was excellent with complete recovery. The second and third patients had what we believe was tracheobronchial pseudomembranous aspergillosis. The precise reason for this complication in the second patient is unknown. The third patient was immunosuppressed and developed tracheobronchial aspergillosis. Despite aggressive therapy, both of these patients died. Diagnostic bronchoscopy was helpful in detecting the airway abnormalities and for obtaining respiratory specimens for culture. CONCLUSIONS: These cases show the diverse tracheobronchial manifestations of Aspergillus species. Diagnostic bronchoscopy was helpful in the diagnosis of airway involvement by aspergillus.
