Post-tuberculosis mycetoma: bronchoscopic removal

A 76‐year‐old male non‐smoker presented to our institution with cough and haemoptysis. He had been treated for cavitatory pulmonary Mycobacterium tuberculosis of the right upper lobe 10 years previously. Chest radiograph and subsequent computed tomography (CT) of the chest demonstrated a right upper cavity containing a mass suspicious for mycetoma. Flexible bronchoscopy under conscious sedation demonstrated a mass obstructing the anterior segment of the right upper lobe. The abnormality was subsequently removed using a flexible endobronchial cryoprobe. Histopathological analysis demonstrated abundant fungal organisms morphologically consistent with Aspergillus species. Microbiological culture of the bronchoalveolar lavage (BAL) from the cavity isolated both Aspergillus fumigatus and Staphylococcus aureus. The patient was commenced on the anti‐fungal drug posaconazole and received a course of flucloxacillin. Three months later, there was no endobronchial obstruction and lavage of the affected cavity again isolated Staphylococcus aureus without Aspergillus species. Repeat thoracic CT and flexible bronchoscopy demonstrated no further re‐occurrence of the mycetoma at 3 months

Post-tuberculosis mycetoma: bronchoscopic removal

A 76‐year‐old male non‐smoker presented to our institution with cough and haemoptysis. He had been treated for cavitatory pulmonary Mycobacterium tuberculosis of the right upper lobe 10 years previously. Chest radiograph and subsequent computed tomography (CT) of the chest demonstrated a right upper cavity containing a mass suspicious for mycetoma. Flexible bronchoscopy under conscious sedation demonstrated a mass obstructing the anterior segment of the right upper lobe. The abnormality was subsequently removed using a flexible endobronchial cryoprobe. Histopathological analysis demonstrated abundant fungal organisms morphologically consistent with Aspergillus species. Microbiological culture of the bronchoalveolar lavage (BAL) from the cavity isolated both Aspergillus fumigatus and Staphylococcus aureus. The patient was commenced on the anti‐fungal drug posaconazole and received a course of flucloxacillin. Three months later, there was no endobronchial obstruction and lavage of the affected cavity again isolated Staphylococcus aureus without Aspergillus species. Repeat thoracic CT and flexible bronchoscopy demonstrated no further re‐occurrence of the mycetoma at 3 months

Body composition determinants of radiation dose during abdominopelvic CT

Abstract Objectives We designed a prospective study to investigate the in-vivo relationship between abdominal body composition and radiation exposure to determine the strongest body composition predictor of dose length product (DLP) at CT. Methods Following institutional review board approval, quantitative analysis was performed prospectively on 239 consecutive patients who underwent abdominopelvic CT. DLP, BMI, volumes of abdominal adipose tissue, muscle, bone and solid organs were recorded. Results All measured body composition parameters correlated positively with DLP. Linear regression (R2 = 0.77) revealed that total adipose volume was the strongest predictor of radiation exposure [B (95% CI) = 0.027(0.024–0.030), t=23.068, p < 0.001]. Stepwise linear regression using DLP as the dependent and BMI and total adipose tissue as independent variables demonstrated that total adipose tissue is more predictive of DLP than BMI [B (95% CI) = 16.045 (11.337-20.752), t=6.681, p < 0.001]. Conclusions The volume of adipose tissue was the strongest predictor of radiation exposure in our cohort. Main message • Individual body composition variables correlate with DLP at abdominopelvic CT. • Total abdominal adipose tissue is the strongest predictor of radiation exposure. • Muscle volume is also a significant but weaker predictor of DLP