Case contributed by Dr Karim Hussein


Patient presented to ED with chronic cough.

Patient Data

Age: 50 years
Gender: Female

Well defined rounded density within the right middle lobe. There appears to be an air-crescent sign within the lesion suggesting an aspergilloma (mycetoma).


Within the right middle lobe there is a spherical soft tissue attenuating rounded mass surrounded by a crescent of air (Monad sign).

Note surrounding bronchiectatic changes.


Post-VATS right middle lobe resection.


Pathology report of VATS specimen. Consistent with Aspergilloma.

Case Discussion

Note that the central mass is mobile. On the erect chest x-ray the crescent of air is seen to be superior to the mass. However, on the CT images where the patient is supine the crescent of air is seen to be anterior of the mass.

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Case information

rID: 55754
Published: 25th Sep 2017
Last edited: 14th Aug 2019
System: Chest
Inclusion in quiz mode: Excluded