0:00

Finally, this is a different patient.

0:03

And before I tell you what the pathogen is first,

0:05

we'll focus on the findings.

0:07

We have axial coronal and sagittal lung window images.

0:12

And the most salient finding here in the super segment right

0:15

upper lobe is we have this area of consolidation

0:18

that's more dense centrally with a little bit of, uh,

0:21

lucency immediately surrounding it,

0:23

and then additional density surrounding that.

0:26

Uh, and so that's the main finding in this patient.

0:29

And although not specific, I think this is a very good look

0:32

for some sort of fungal infection.

0:34

This turned out to be something called penicillium

0:37

with co-infection with a bacteria streptomyces,

0:41

which nobody would ever be able

0:43

to diagnose prospectively on a CT scan.

0:46

Um, that's just what showed when it was sampled later.

0:49

But importantly, I want you to recognize this focal

0:53

soft tissue nodule that has this more peripheral kind of

0:58

more loosened and more dense periphery.

1:01

As another example of a fungal infection, easily,

1:05

this could have been thought to be aspergillus

1:07

or some other fungal infection depending on the patient's

1:10

immuno competency.

1:11

But recognizing

1:13

that this could be fungal is the most

1:14

important aspect of this case.

1:16

It is not necessary to know exactly what type of bug.