Fig. 6.1 Toxocara canis and its larva migration in a 66-year-old man with colon cancer who had a history of raw cow liver intake. (a) Lung window of CT scan (2.5-mm section thickness) obtained at lower lobar bronchia level shows nodules (arrows) with surrounding halo sign in both lungs. (b) Coronal reformatted (2.0-mm section thickness) CT scan also demonstrates nodules (arrows) with halo sign

Angioinvasive Pulmonary Aspergillosis

Pathology and Pathogenesis

Central portion of the lesion is typically pale and shows a relatively intact underlying structure in a gross pathologic specimen. The peripheral portion demonstrates a rim of hemorrhage or consolidation. Histologically, coagulative necrosis and its permeation by numerous fungal hyphae are seen (Fig. 6.2). Invasion into smallto medium-sized pulmonary arteries within the necrotic portion is common.

Nodules with ground-glass halo on CT correspond pathologically to the foci of the necrotic lung surrounded by viable but hemorrhagic lung parenchyma [9]. Wedge-shaped pleural-based consolidation areas are related to more extensive intralobular hemorrhage or true parenchymal infarction.

Patient Prognosis

The rate of successful outcomes is increasing with newer antifungal agents. Voriconazole was more effective than amphotericin B as initial therapy for invasive pulmonary aspergillosis and was associated with signiÞcantly improved survival (71 vs. 58 %, respectively). Higher mortality occurred in the patients with extrapulmonary aspergillosis and allogeneic HSCT recipients. Combination antifungal therapy can be given as salvage therapy. The value of aggressive surgical resection for localized form of invasive pulmonary aspergillosis is unclear [10, 11].