Pulmonary aspergilloma is commonly associated with tuberculosis. Pulmonary aspergilloma is found in residual tuberculosis cavities and potential for other pathogens’ infections due to its sufficient oxygen and necrotizing tissue. A 48-year-old woman came with shortness of breath and cough for 7 months. She was diagnosed with pulmonary tuberculosis 9 months ago and was still under anti-tuberculosis drug therapy. She also suffered from type II diabetes mellitus. Chest examination showed vesicular sound decreased in third to fourth left intercostal spaces. A chest x-ray revealed a thick-walled cavity with the air-crescent sign in the left upper lobe lung leads to aspergilloma and active pulmonary tuberculosis. This finding was confirmed by the contrast-enhanced CT scan of the chest and continued to lobectomy. Histological examination confirmed the presence of a granuloma formation, necrosis, hyphae structure with the conclusion of Aspergillus sp. infection.

Covid-19 is a global pandemic which currently becomes the world's concern. There were various studies to overcome the problem of high mortality due to the infection of the SARS Cov-2 virus. Vaccine is one of the solutions to lessen the global burden. Vaccine is expected to produce immunity for community health. The scientists are investigating the effectiveness of the vaccine. Some vaccinated Covid-19 patients can still be infected by the virus even with moderate or severe symptoms. Chest x-ray is one of the modalities to see clinical progress. This study aims to compare the chest x-ray of hospitalized patients who have been vaccinated and those who have not. There were two groups of 60 hospitalized patients aged 18-50 years, namely the vaccinated and non-vaccinated groups. Patients with type II diabetes mellitus, hypertension, heart failure or autoimmune disease were excluded from the sample. Assessment of severity level through chest x-ray was done by calculating Brixia score. The calculation of Brixia score was carried out by three researchers having parallel levels of competence with a tolerance of differences of less than 5%. Bivariate analysis was conducted to compare Brixia scores between the two groups. A total of 8 male (26,7%) and 22 female (73,3%) patients in the vaccinated group had lower Brixia scores with a mean score of 1,53 + 1,27 compared to 30 patients (60% male, 40% female) in the non-vaccinated group with a mean of 6,0 + 2,61 and p value of 0.001. There were no death cases in all samples. There is a difference in the average Brixia score with a lower tendency of severity in the vaccinated group compared to the non-vaccinated group. Vaccine is useful for raising immunity so that it avoids severe conditions due to the SARS Cov-2 virus infection

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Objective:Rare disease Background:Pulmonary alveolar microlithiasis (PAM) is an uncommon pulmonary disease characterized by deposition of microliths in the alveoli. In this report, we describe the first ever documented case from the Indonesian population of an adult patient who was diagnosed with PAM based on clinical and pathognomonic radiological findings. Case Report:A 57-year-old man with a 12-year history of progressive shortness of breath on exertion was admitted to our center. When the lungs were listened to, there were coarse crackles and wheezing during inspiration, and the vesicular sound was lower in all thoracic regions. Cardiac auscultation was unremarkable, with fingers having a clubbed drumstick appearance. Bronchoscopy revealed all patent branches of the bronchial tree. Unfortunately, the microliths were absent, and the histology findings from bronchoalveolar lavage and transbronchial lung biopsy were inconclusive. Radiologic features of a chest radiograph show the characteristic finding of multiple diffuse micronodules with a high density in both lungs. A high-resolution computed tomography (HRCT) scan corroborated the typical findings of extensive intraparenchymal calcified micronodules with diffuse groundglass attenuation areas. Black pleural line signs were also seen. Conclusions:PAM is a rare disease with a chronic clinical course and varying manifestations according to phase, but progressive deterioration may result in a poor prognosis. It is particularly important for clinicians to be able to narrow down the differential diagnosis of multiple diffuse micronodules of the lungs. When a non-invasive method of diagnosis is preferred, chest X-rays and, even better, HRCT should be used to find the characteristic features of alveolar microlithiasis.

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