Case contributed by Naeem Jagirdar
Diagnosis almost certain


Smoker with a history of breast cancer, presenting with fever and increasing breathlessness on a background of chronic obstructive airway disease.

Patient Data

Age: 85 years
Gender: Female

Elevated left hemidiaphragm with crowding of the left ribs are in keeping with decreased left lung volume. Air crescent sign over the left upper lobe.


CT of the chest demonstrates a cavity in the apex of the left lung, with a central soft-tissue attenuation mass surrounded by air (Monod sign). There is also a thickening of the wall and adjacent pleura.

Case Discussion

Features are consistent with an aspergilloma, presumably occupying a pre-existing cavity due to COPD or prior tuberculosis.

Aspergillosis is commonly seen in immunocompromised patients. On CT, aspergilloma is characterized by a mass with soft-tissue attenuation within a lung cavity. The mass is typically separated from the cavity wall by an airspace - air crescent sign and is often associated with thickening of the wall and adjacent pleura.

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