Q J Med 2015; 108:431–432
Correspondence
Teratoma: another cause of the air crescent sign
E. Marchiori G. Zanetti M.M. Barreto Department of Radiology, Faculty of Medicine, Rio de Janeiro Federal University, Rio de Janeiro, Brazil. email: [email protected]
References 1. Tseng YY, Chen CH. Air crescent sign: not always due to fungal infection. QJM 2015; 108:255–6. 2. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Mu¨ller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008; 246:697–722. 3. Gazzoni FF, Severo LC, Marchiori E, Guimara˜es MD, Garcia TS, Irion KL, et al. Pulmonary diseases with imaging findings mimicking aspergilloma. Lung 2014; 192:347–57. 4. Fred HL, Gardiner CL. The air crescent sign: causes and characteristics. Tex Heart Inst J 2009; 36:264–5.
doi:10.1093/qjmed/hcv034 Advance Access Publication 6 February 2015
Reply: Teratoma: another cause of the air-crescent sign Figure 1. A chest-computed tomography image revealed a thick-walled cavity in the left upper lobe of the lung with an air crescent sign (arrows) and an intracavitary mass (asterisk).
Dear editor Dr Edson reported another interested case with air-crescent sign due to mature teratoma. This case is also a thick-wall cavity lesion but not
! The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 13, 2015
We read with great interest the well-written article by Tseng and Chen,1 who described the case of a 65-year-old woman who presented with hemoptysis and a cavitary lesion in the right lung with an air crescent sign and an intracavitary fungus ball-like mass. The final diagnosis was lung carcinoma. The authors highlighted the importance of cavity wall thickness for the differential diagnosis, reporting that cavity lung cancer rarely presents with a thinwalled cavity. We would like to report the case of a 22-year-old woman who also presented with hemoptysis and a thick-walled cavitary lesion on chest X-ray. She had received therapy for pulmonary tuberculosis for 1 year from other institution, in the absence of laboratory evidence of Mycobacterium tuberculosis. Chest-computed tomography revealed a thickwalled cavity in the left upper lobe with an air crescent sign and an intracavitary mass (Figure 1). The final diagnosis was a mature teratoma. The air crescent sign is a collection of air in a crescentic shape that separates the wall of a cavity from an inner mass. This sign is often considered to be characteristic of Aspergillus colonization of pre-
existing cavities or the retraction of infarcted lung in angioinvasive aspergillosis.2 Because Aspergillus spp. are the most commonly implicated fungi, these fungal masses are also called aspergillomas.3 Although Aspergillus is the most frequent cause of the air crescent sign, this finding has been reported in association with a variety of other conditions, including tuberculosis (blood clot or Rasmussen aneurysm), hydatic cysts, lung cancer, bacterial lung abscess, other fungal or fungal-like conditions (coccidioidomycosis, actinomycosis, nocardiosis, candidiasis), and intracavitary hematoma.1–4 In conclusion, teratoma should be considered in the differential diagnosis of the air crescent sign.
432
Correspondence
due to fungal infection. As we report in our case,1 the pulmonary air-crescent sign is typically seen with a mycetoma located in a preexisting thinwalled cavity with a smooth inner margin, most often formed by a previous tuberculous infection.2 The mycetoma may move when the patient’s position changes. Moreover, thick-walled cavity with irregular margin should be considered other diagnosis rather than fungal infection. From ou case and Dr Edson case, we suggest that cavitary neoplasms, no matter benign or malignant, should be taken into consideration when pulmonary aircrescent sign with thick-walled cavity is noted. Y.Y. Tseng Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
C.-H. Chen Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan and Department of Respiratory Therapy, China Medical University, Taichung, Taiwan, Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. e-mail: [email protected]
References 1. Tseng YY, Chen CH. Air crescent sign: not always due to fungal infection. QJM 2015; 108:255–6. 2. Abramson S. The air crescent sign. Radiology 2001; 218:230–2.
doi:10.1093/qjmed/hcv036 Advance Access Publication 6 February 2015
Downloaded from by guest on November 13, 2015
Correspondence
Teratoma: another cause of the air crescent sign
E. Marchiori G. Zanetti M.M. Barreto Department of Radiology, Faculty of Medicine, Rio de Janeiro Federal University, Rio de Janeiro, Brazil. email: [email protected]
References 1. Tseng YY, Chen CH. Air crescent sign: not always due to fungal infection. QJM 2015; 108:255–6. 2. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Mu¨ller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008; 246:697–722. 3. Gazzoni FF, Severo LC, Marchiori E, Guimara˜es MD, Garcia TS, Irion KL, et al. Pulmonary diseases with imaging findings mimicking aspergilloma. Lung 2014; 192:347–57. 4. Fred HL, Gardiner CL. The air crescent sign: causes and characteristics. Tex Heart Inst J 2009; 36:264–5.
doi:10.1093/qjmed/hcv034 Advance Access Publication 6 February 2015
Reply: Teratoma: another cause of the air-crescent sign Figure 1. A chest-computed tomography image revealed a thick-walled cavity in the left upper lobe of the lung with an air crescent sign (arrows) and an intracavitary mass (asterisk).
Dear editor Dr Edson reported another interested case with air-crescent sign due to mature teratoma. This case is also a thick-wall cavity lesion but not
! The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 13, 2015
We read with great interest the well-written article by Tseng and Chen,1 who described the case of a 65-year-old woman who presented with hemoptysis and a cavitary lesion in the right lung with an air crescent sign and an intracavitary fungus ball-like mass. The final diagnosis was lung carcinoma. The authors highlighted the importance of cavity wall thickness for the differential diagnosis, reporting that cavity lung cancer rarely presents with a thinwalled cavity. We would like to report the case of a 22-year-old woman who also presented with hemoptysis and a thick-walled cavitary lesion on chest X-ray. She had received therapy for pulmonary tuberculosis for 1 year from other institution, in the absence of laboratory evidence of Mycobacterium tuberculosis. Chest-computed tomography revealed a thickwalled cavity in the left upper lobe with an air crescent sign and an intracavitary mass (Figure 1). The final diagnosis was a mature teratoma. The air crescent sign is a collection of air in a crescentic shape that separates the wall of a cavity from an inner mass. This sign is often considered to be characteristic of Aspergillus colonization of pre-
existing cavities or the retraction of infarcted lung in angioinvasive aspergillosis.2 Because Aspergillus spp. are the most commonly implicated fungi, these fungal masses are also called aspergillomas.3 Although Aspergillus is the most frequent cause of the air crescent sign, this finding has been reported in association with a variety of other conditions, including tuberculosis (blood clot or Rasmussen aneurysm), hydatic cysts, lung cancer, bacterial lung abscess, other fungal or fungal-like conditions (coccidioidomycosis, actinomycosis, nocardiosis, candidiasis), and intracavitary hematoma.1–4 In conclusion, teratoma should be considered in the differential diagnosis of the air crescent sign.
432
Correspondence
due to fungal infection. As we report in our case,1 the pulmonary air-crescent sign is typically seen with a mycetoma located in a preexisting thinwalled cavity with a smooth inner margin, most often formed by a previous tuberculous infection.2 The mycetoma may move when the patient’s position changes. Moreover, thick-walled cavity with irregular margin should be considered other diagnosis rather than fungal infection. From ou case and Dr Edson case, we suggest that cavitary neoplasms, no matter benign or malignant, should be taken into consideration when pulmonary aircrescent sign with thick-walled cavity is noted. Y.Y. Tseng Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
C.-H. Chen Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan and Department of Respiratory Therapy, China Medical University, Taichung, Taiwan, Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. e-mail: [email protected]
References 1. Tseng YY, Chen CH. Air crescent sign: not always due to fungal infection. QJM 2015; 108:255–6. 2. Abramson S. The air crescent sign. Radiology 2001; 218:230–2.
doi:10.1093/qjmed/hcv036 Advance Access Publication 6 February 2015
Downloaded from by guest on November 13, 2015
