'Monod' and 'air crescent' sign in aspergilloma.
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چکیده
To cite: Sharma S, Dubey SK, Kumar N, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-200936 DESCRIPTION A 62-year-old male patient presented with a symptom of haemoptysis for 15 days. There was history of pulmonary Koch’s for which he took complete treatment 11 years ago. In the CT scan of the chest, there was an irregular-shaped cavity in the right apical zone, with an oval-shaped mass within it (figure 1). The mass was separated from the wall of the cavity by a crescent-shaped airspace; it is known as an ‘air crescent sign’. This finding is typical of aspergilloma, but is also found in pulmonary tuberculosis, hydatid cyst, pulmonary abscess, bronchogenic carcinoma and Pneumocystis carinii pneumonia. In aspergilloma, this mass usually moves within the cavity when the patient changes the position and the sign is called a ‘Monod sign’. A CT scan of the chest was also performed in the prone position, where it was seen to have moved to the dependent area thus confirming the diagnosis (figure 2). Aspergilloma occurs in patients with normal immunity with pre-existing cavities. Most commonly they colonise cavity secondary to pulmonary tuberculosis; later accounts for 25–80% of cases depending on its prevalence in the population. Most aspergillomas are asymptomatic. The cavity is essentially isolated, and systemic administration of antifungal does not have much role. They need expectant management with close follow-up. Haemoptysis secondary to reactive vascular granulation tissue is the most common presentation. For brisk haemoptysis, an angiography and a selective bronchial artery embolisation can be life-saving. But if it fails, or in cases of recurrent haemoptysis, surgical excision remains the gold standard. As this patient was having haemoptysis, he was referred to the Cardio Thoracic Vascular Surgery department. He was discharged after symptomatic treatment and antifungal therapy. He again had massive haemoptysis 1 month later, was admitted and a lobectomy was performed as a permanent treatment. The patient survived.
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Explanation: Monod sign indicates the presence of a mycetoma within a lung cavity. This radiographic appearance of a “uniform, rounded opacity which isytopped by a clear crescent” was described in 1954 by Pesle and Monod.1 Free movement of the mass helps distinguish Monod sign from similar-appearing radiographic signs in which the lesion is fixed, and supports the presence of a mycetoma. Howeve...
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ورودعنوان ژورنال:
- BMJ case reports
دوره 2013 شماره
صفحات -
تاریخ انتشار 2013