Case contributed by Dr Ngo Tuan Minh


History of pulmonary tuberculosis a long time ago. Presented with hemoptysis 1 week before admission

Patient Data

Age: 80 years
Gender: Male

CT shows an intra-cavitary mass in the left upper lobe. The mobility of mass is seen with the change between prone and supine positioning which suggests the Monod sign. Punctate calcification nodules and scars in the bilateral upper lobes also can be seen. 


CT-guided core-needle biopsy of the mass was performed with the prone approach. CT demonstrates an 18-gauge sample notch positioned within the lesion in the left upper lobe.


Photomicrograph (200x and 400x) shows septate hyphae branching at an angle of approximately 45° which suggests the feature of Aspergillus fumigatus.

Case Discussion

This patient illustrates the typical features of an aspergilloma.

He had the presentation with hemoptysis of aspergilloma which grows in a secondary pre-existing lung cavity of tuberculosis. CT shows the Monod sign which is a typical finding of aspergilloma
The final diagnosis was possible after appropriating histological samples were obtained through the CT guided transthoracic core needle biopsy.

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