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Case Reports
. 2017 Aug 7:2017:bcr2017221140.
doi: 10.1136/bcr-2017-221140.

Postsurgical mediastinal aspergilloma masquerading as malignancy

Saira Farid  1 , Omar AbuSaleh  1 , Nana Aburjania  1 , Muhammad Rizwan Sohail  1
Affiliations
Case Reports

Postsurgical mediastinal aspergilloma masquerading as malignancy

Saira Farid et al. BMJ Case Rep. .

Abstract

A 70-year-old man with non-ischaemic dilated cardiomyopathy presented with symptoms of fatigue, chills and unintentional weight loss over the past 2 months. Initial evaluation revealed anaemia, peripheral leucocytosis and elevated inflammatory markers. Results of an oesophagogastroduodenoscopy, colonoscopy, blood bacterial and fungal cultures and bone marrow biopsy were negative. An 18F-FDG positron-emission tomography-CT demonstrated an indeterminate, intensely FDG-avid 5 cm × 2 cm × 5.6 cm × 6.7 cm mass centred within the junction of the superior vena cava and right atrium, suggestive of probable malignancy versus an inflammatory thrombus. After multidisciplinary consideration, patient underwent a diagnostic minithoracotomy and a thick fibrotic mediastinal mass was visualised and evacuated. The encapsulated mass contained thick, white creamy liquid that appeared to be purulent/necrotic material. The biopsies of the capsule wall on frozen section demonstrated fungal elements consistent with Aspergillosis species. Fungal culture confirmed diagnosis of Aspergillus fumigatus.

Keywords: cardiothoracic surgery; infectious diseases.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
An indeterminant, intensely FDG avid (standardized pptake value (SUV), maximum 14.2), 5.2 cm × 5.6 cm × 6.7 cm mass is centred within the junction of the superior vena cava and right cardiac atrium.
Figure 2
Figure 2
CT angiography of chest showing an ill-defined mass (arrow) at the superior vena cava and right atrium junction.
Figure 3
Figure 3
Intraoperative findings of a fibrotic mass with tissue necrosis and purulent material in the encapsulated cavity.
See this image and copyright information in PMC

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