Nizami S Q.
Aspergillosis presenting as superior vena-caval obstruction.
Pak J Pathol Jan ;7(3):147-8.

This 10 year old girl weighing 17 kg presented with complaints of fever, cough and progressively increasing breathlessness for the last two months. She had no history of hemoptysis nor any history of bronchial asthma or tuberculosis in the family. The breathlessness had increased considerably during the past few clays. On examination she was a grade III malnourished girl (weight 17 kg, < 3rd gentile for age), having puffiness of face, mild swelling of the neck with visible dilated and tortuous neck veins more prominent on the right side of the neck. She was in severe respiratory distress and unable to lie flat on bed. She was mildly anemic but had no cyanosis, jaundice or dehydration. Her pulse rate was 120/min, temperature 37°C, blood pressure 110/70 mmHg and respiratory rate 36/min. Systemic examination revealed respiratory distress with dullness on the right side of the chest from second to fifth intercostal space, and decreased breath sounds. Clinically she was assessed to have superior vena Caval obstruction secondary to compression by an intrathoracic mass. An X-ray chest showed homogenous opacity involving upper and middle segments of the right hung without any deviation of trachea. A presumptive diagnosis of lymphoma causing compression of superior versa-Lava was made. A true cut needle biopsy was obtained which showed extensive fibrosis with ill-defined granulonua, epithelial cells, lymphocytes and multinucleated giant cells. Fungal staining revealed septate hyphae. Amphotericin B was started to treat the fungal infection without much improvement. A repeat biopsy of mediastinal mass along with an excisional biopsy of lymph nodes again showed fungal organisms in the mediastinal mass and no evidence of malignancy. Fungal culture of the mass obtained on the biopsy grew few colonies of Aspergillus flavus.

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