慢性肺曲霉病的诊疗和管理课件.ppt

慢性肺曲霉病的诊疗和管理;目录;目录;Definitions of CPA;目录;Present by David Denning ;;Single (simple) pulmonary aspergilloma is a single fungal ball in a single pulmonary cavity. There is no progression over months of observation and very few, if any pulmonary or systemic symptoms and serological or microbiological evidence implicating Aspergillus spp.;CCPA, formerly called complex aspergilloma, usually shows multiple cavities, which may or may not contain an aspergilloma , in association with pulmonary and systemic symptoms and raised inflammatory markers, over at least 3 months of observation. Untreated, over years, these cavities enlarge and coalesce, developing pericavitary infiltrates or perforating into the pleura, and an aspergilloma may appear or disappear. Thus serological or microbiological evidence implicating Aspergillus spp. is required for diagnosis.;Imaging showing chronic cavitary pulmonary aspergillosis showing an axial view with a) lung and b) mediastinal windows at the level of the right upper lobe. Multiple cavities are visible with a fungus ball lying within the largest one. The wall of the cavities cannot be distinguished from the thickened pleura or the neighbouring alveolar consolidation. The extra pleural fat is hyperattenuated (white arrows). *: the dilated oesophagus should not be confused with a cavity.;CFPA is often an end result from untreated CCPA. Extensive fibrosis with fibrotic destruction of at least two lobes of lung complicating CCPA, leading to a major loss of lung function. Usually the fibrosis is solid in appearance, but large or small cavities with surrounding fibrosis may be seen. Serological or microbiological evidence implicating Aspergillus spp. is required for diagnosis. One or more aspergillomas may be present.;One or more nodules (3 cm), which do not usually cavitate, are an unusual form of CPA . They may mimic carcinoma of the lung, metastases, cryptococcal nodule, coccidioidomycosis or other rare pathogens and can only be definitively