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LETTER TO THE EDITOR
Year : 2011  |  Volume : 15  |  Issue : 7  |  Page : 273-274

Cavity in lung in a case of Cushing's disease


Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt - 110 010, India

Date of Web Publication13-Sep-2011

Correspondence Address:
M K Garg
Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt - 110 010
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.84886

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How to cite this article:
Kharb S, Gundgurthi A, Dutta M K, Garg M K. Cavity in lung in a case of Cushing's disease. Indian J Endocr Metab 2011;15, Suppl S3:273-4

How to cite this URL:
Kharb S, Gundgurthi A, Dutta M K, Garg M K. Cavity in lung in a case of Cushing's disease. Indian J Endocr Metab [serial online] 2011 [cited 2020 Oct 27];15, Suppl S3:273-4. Available from: https://www.ijem.in/text.asp?2011/15/7/273/84886

Sir,

A 32-year-old lady, known case of Cushing's disease, presented with persistent cough of 8 weeks duration. Cough was nonproductive without any postural or diurnal variation. Cough was not associated with any history of hemoptysis, fever, and night sweats. She gave history of tuberculosis lung for which she had received full course antitubercular therapy 6 months back. On examination, she had Cushingoid body habitus. On respiratory examination, bronchial breath sounds were heard at left supraclavicular, infraclavicular, and upper axillary areas. X-ray chest PA view showed two colocated thin-walled cavitatory lesions in right lung upper zone with a well-defined nodular shadows inside it which moved with change in position (Monad's sign) [Figure 1]. CECT chest was also indicative of thin-walled cavitatory lesions in right lung apex with soft tissue mass inside it [Figure 2]. Smear and culture results were negative for acid-fast bacilli. Smear and culture results were positive for Aspergillus fumigatus. The patient was treated with itraconazole. Saprophytic aspergillosis results from colonization of a preexisting pulmonary cavity and typically leads to the formation of a fungus ball, or mycetoma, within the cavity. Although pulmonary mycetoma may be asymptomatic, patients can present with life-threatening hemoptysis.
Figure 1: Chest X-ray PA and lateral view showing cavity and movement of fungal ball

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Figure 2: CT scan of chest showing fungal ball in preexisting cavity

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Cavitatory lesion in lung is defined radiologically as "a lucency within a zone of pulmonary consolidation, a mass, or a nodule; hence, a lucent area within the lung that may or may not contain a fluid level and that is surrounded by a wall, usually of varied thickness." [1]

Cavitatory lesion in lung can be infectious or noninfectious and thick or thin walled. Cavities with wall thickness upto 4 mm are thin-walled, while cavities with wall thickness ≥ 5 mm are thick walled. Thin-walled cavities are usually nonmalignant; cavities with wall thickness between 5 and 15 mm are mixed and cavities with wall thickness more than 15 mm are mostly malignant. Thin-walled cavitatory lesions in lung can be caused by tuberculosis, congenital or acquired bullae, coccidioidomycosis, posttraumatic cysts, and few metastatic carcinomas. While fine cavitatory lesion in lung with fungal ball should make us consider diagnosis of aspergillosis; however, similar appearance may rarely also be seen with blood or fibrin in cavity. [2]

Cushing's disease is an immune-compromised state characterized by excess cortisol levels secondary to pituitary adenoma. It is associated with impaired cell-mediated immunity, augmented by deficient neutrophil, and macrophage function. [3]

Aspergilloma is most common form of lung involvement due to aspergillus. It most commonly occurs in already existing cavity which is most commonly caused by Mycobacterium tuberculosis in India. Aspergillous growth is facilitated by inadequate drainage in these cavities. It usually does not invade pulmonary parenchyma or blood vessels. Mostly it remains stable and may spontaneously regress in 10% of cases. Symptomatic aspergilloma can be treated by various modalities, varying from oral itraconazle to local instillation of antifungal drugs in cavity, to surgical resection and bronchial artery embolization in case of hemoptysis. [4]

 
   References Top

1.Tuddenham WJ. Glossary of terms for thoracic radiology: Recommendations of the Nomenclature Committee of the Fleischner Society. AJR Am J Roentgenol 1984;143:509-17.  Back to cited text no. 1
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2.Gadkowski LB, Stout JE. Cavitary pulmonary disease. Clin Microbiol Rev 2008;21:305-33.  Back to cited text no. 2
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3.Graham BS, Tucker WS Jr. Opportunistic infections in endogenous Cushing's syndrome. Ann Intern Med 1984;101:334-8.  Back to cited text no. 3
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4.Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest 2002;121:1988-99.  Back to cited text no. 4
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    Figures

  [Figure 1], [Figure 2]



 

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