Presentation
Known case of pulmonary tuberculosis referred for recent haemoptysis.
Patient Data
Mild mosaic attenuation pattern is seen in both lungs.
The left lung relatively decreased in volume.
A 48 mm cavitary lesion with a fungus ball within is noted in the left upper lobe. Areas of bronchiectasis are also scattered in the left lung.
An enlarged lymph node is seen in the right paratracheal region with SAD of 20 mm.
Case Discussion
Aspergilloma is a mass-like fungus ball, a non-invasive form of pulmonary aspergillosis, typically classified as a subtype of chronic pulmonary aspergillosis. It often occurs in patients with normal immunity but structurally abnormal lungs, with pre-existing cavities, most commonly tuberculosis, as noted in this case.
On CT, a rounded mass in a lung cavity suggests a fungus ball, and the air around the mass within the cavitary lesion is known as the Monod sign.
An asymptomatic aspergilloma or minor symptoms may not require treatment. In case of severe haemoptysis, emergency angiography followed by bronchial artery embolisation can be life-saving. Surgical removal with lobectomy is the last resort for persistent bleeding.
It should noted that, although the term mycetoma is frequently used to describe these fungal balls, it is an incorrect term to use.
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