醫學筆記匯整 ED Notes

1. Aspergilloma 麴菌球 : 
   先有 TB 開洞
   之後住進來形成 Ball in hole
   不同 view 會滾來滾去
   侵犯到血管可能 massive hemoptysis
    
2. Invasive Aspergillosis 麴菌病 :
   肺部感染
   出現在 immunecompromise
   之後可能擴散全身, 造成腦部 Hemorrage infarction
    
3. Chronic necrotizing Aspergillus pneumonia
   慢性壞死性麴菌病 :
   亞急性, 病人免疫力不足
   慢慢侵犯肺部, 最後纖維化
    
4. ABPA ( Allergic bronchopulmonary aspergillosis )
   過敏性支氣管麴菌病 : 
   對麴菌過敏
   大部份都發生在原本就有氣喘的病人
   也有少部份的 ABPA 不合併氣喘病 
   
   反覆的發生 ABPA 會造成 Bronchiectasis 或 肺纖維化
   bronchospasm and bronchial wall oedema, which is IgE-mediated
   Ultimately, there is bronchial wall damage with loss of muscle and bronchial wall cartilage
   resulting in bronchiectasis ( typically central bronchiectasis ) 
    

   * Laboratory findings include :
      - elevated Aspergillus specific IgE
      - elevated precipitating IgG against Aspergillus
      - peripheral eosinophilia
      - positive skin test

 重點 :  氣喘 + Central bronchiectasis + Eosinophilia + IgE