Presentation
Cough and shortness of breath.
Patient Data
A large cavitary lesion with surrounding consolidation and ground glass opacities in the right lower lobe. Irregular & intersecting strands are seen within the cavitary lesions along with the peri cavitary consolidations–giving the appearance of a "bird's nest sign.
Multiple patchy areas of centrilobular nodules and tree-in-bud nodules with mild interlobular septal thickening are scattered in the bilateral lung. A few small patchy areas of consolidation are also scattered in the left lower lobe.
The endotracheal tube, central line, and nasogastric tube are seen in situ.
The galactomannan antigen detection test is positive and the culture of BAL fluid showed the growth of a mixture of Candida tropicalis and Aspergillus fumigatus.
Case Discussion
The above findings are suggestive of invasive pulmonary aspergillosis. Unfortunately patient succumbed to death.
The bird's nest sign is suggestive of invasive pulmonary fungal infection in susceptible patient populations.
Co-author: Dr. Archana Kumari (DNB, Radiodiagnosis).
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