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Aim: To evaluate clinical manifestations of Aspergillus infections in our pulmonology practice., Methods: Between 2002-2009, we assessed retrospectively and prospectively, Aspergillus related diseases in patients admitted in Clinical Hospital of Pneumology from Cluj-Napoca, Romania. Positive diagnosis was based on identification of Aspergillus speciae (A spp) on Sabouraud medium, pathological, or immunological proves., Results: 83 patients were included. A spp was isolated in 73 patients from: sputum 46, bronchial lavages (BL) 17, both sputum and BL 4, sputum and nasal secretion 1, or from surgical samples 5 cases. In those 10 cases without A spp positive cultures, diagnosis was confirmed by pathologic examination on surgical or bronchoscopical samples in 6 and 2 cases respectively. 76 patients had previous chronic respiratory diseases and 7 had nonrespiratory chronic diseases. We identified the following clinical forms: chronic cavitary aspergillosis 46 cases, aspergillus tracheobronchitis 19 cases, allergic aspergillosis 15 cases, invasive aspergillosis 3 cases. We observed a poor definition on nosological forms, diagnosis like "pulmonary aspergillosis" or "aspergilloma" were the most common. In 12 cases no clinical significance was attributed for detection A spp in bronchial smears. 60 patients supported specific management: antifungal therapy in 38 cases, surgical procedures in 14 cases and both methods in 8 cases, with many differences in treatment and follow-up., Conclusions: Chronic cavitary aspergillosis was the most frequent clinical form observed in our pulmonology practice. Using the clinical guidelines for fungal respiratory infections we can avoid the wrong diagnosis and then include a correct antifungal treatment in the complex management of our chronic pulmonary patients.

Vein pulmonary anomalies are seldom met. They have a prevalence of 0.4-0.7% of the cases (according to the American authors). The case under discussion is a 68-year-old patient, who was admitted in the hospital for hemoptysis in low quantity but recurrent, physical asteny, fever and weight loss. The onset had been two months before admission to the hospital. The thoracic X-ray shows opacity at the left apex with marked subcostal and costal intensity, with a homogenous area of 5/6 cm. The thoracic CT exam shows multiple bilateral fibronodular images and the left upper lobe shows a cavitary image with regular and thin walls; intracavitary there is an oval formation with mixed densities of approximate 3.5/4/4.5 cm, which suggests a lung aspergilloma. Surgery will be performed--left upper lobectomy associated with atypical resection from the left Fowler segment. During the surgery it is noticed that the left upper pulmonary vein is abnormaly in the left pulmonary hilum. It has a cranial trajectory, runs in parallel with the left phrenic nerve on the mediastinal surface of the left upper lobe then goes in the mediastinum and pours into the left vein branchocefalic trunk. The post-surgery recovery was slowly favourable with complete pulmonary re-expansion, but with the persistence of the aerial losses which imposed pleural drainage for a period of over 2 weeks.