Cavitary alveolar sarcoidosis complicated by an aspergilloma

Abstract

Cavitation in pulmonary sarcoidosis is rather unusual and even rarer in the alveolar form of the disease. A review of the literature revealed only 13 documented patients with cavitating alveolar sarcoidosis. Of the 13 patients, clinical information was available in only eight cases. Aspergilloma complicating cavitary alveolar sarcoidosis has been documented only once before. A 38-year-old woman with progressive dyspnoea for 3 years presented owing to a bout of haemoptysis. Imaging prior to presentation demonstrated mediastinal lymphadenopathy and coalescent parenchymal alveolar opacities along with air bronchograms, suggestive of alveolar sarcoidosis. On presentation, cavitations were visible in both lungs within the consolidation along with an intracavitary mass in the left upper lobe, which on evaluation was recognised as an aspergilloma. Bronchoscopy disclosed non-caseating granulomas on histopathology confirming pulmonary sarcoidosis. Cavitary alveolar sarcoidosis with aspergilloma formation can result in a diagnostic dilemma, especially in endemic tuberculous areas.

Figure 1

Contrast-enhanced CT high resolution (mediastinal window) prior to presentation, showing bilateral hilar lymphadenopathy along with bilateral perihilar consolidation.

Figure 2

Contrast-enhanced CT high resolution (lung window) prior to presentation, showing bilateral perihilar consolidation along with bilateral air bronchograms and peribronchial beading.

Figure 3

Contrast-enhanced CT high resolution (mediastinal window) on presentation, showing regression of the mediastinal lymph nodes.

Figure 4

Contrast-enhanced CT high resolution (lung window) on presentation, showing bilateral cavitations along with an intracavitary mass in the left upper lobe.

Figure 5

Chest radiographs (A) on initial presentation; (B) 2 months post-therapy, showing marked resolution of the alveolar shadows.