Clinical-pathologic conference in general thoracic surgery: Bilateral lung transplantation for sarcoidosis with aspergilloma G.Alexander Patterson, MD

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Clinical-pathologic conference in general thoracic surgery: Bilateral lung transplantation for sarcoidosis with aspergilloma G.Alexander Patterson, MD The Journal of Thoracic and Cardiovascular Surgery Volume 124, Issue 1, Pages 171-175 (July 2002) DOI: 10.1067/mtc.2002.122139 Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Chest radiograph demonstrates extensive bullous formation and associated hyperinflation. Upper lobe scarring with hilar retraction is seen. An opacity (arrow), likely a fungus ball, is seen within a large cystic space in the left upper hemithorax. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 171-175DOI: (10.1067/mtc.2002.122139) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Computed tomographic image confirms dependent opacity (arrows), likely a fungus ball, in a large cystic space in the left hemithorax. Bronchial distortion (arrowheads) is also noted. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 171-175DOI: (10.1067/mtc.2002.122139) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 The initial postoperative chest radiograph (A) demonstrates moderate left perihilar and left basilar opacity, likely representing edema and atelectasis. Pneumonia could have a similar radiographic appearance. Improvement was noted by the third postoperative day (B). The Journal of Thoracic and Cardiovascular Surgery 2002 124, 171-175DOI: (10.1067/mtc.2002.122139) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Sections of the hilar lymph nodes showing marked elastosis and sclerosis. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 171-175DOI: (10.1067/mtc.2002.122139) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 5 Photomicrograph of larger airways with intramural sclerosis. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 171-175DOI: (10.1067/mtc.2002.122139) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 6 Sclerosis surrounding a small airway. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 171-175DOI: (10.1067/mtc.2002.122139) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 7 Terminal bronchiole surrounded by sclerosis with adjacent parenchymal emphysema. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 171-175DOI: (10.1067/mtc.2002.122139) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 8 Section of a bulla wall. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 171-175DOI: (10.1067/mtc.2002.122139) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 9 Sections of the wall of the aspergillus cavity showing mixed inflammatory infiltrate. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 171-175DOI: (10.1067/mtc.2002.122139) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 10 Low-magnification view of bulla contents showing inflammatory debris and hyphae. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 171-175DOI: (10.1067/mtc.2002.122139) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 11 High-magnification view of branching hyphae. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 171-175DOI: (10.1067/mtc.2002.122139) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 12 Sections through one of the larger pulmonary arteries showing intimal thickening. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 171-175DOI: (10.1067/mtc.2002.122139) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions