Presentation
Hospital admission with acute renal failure. No pulmonary symptoms.
Patient Data
A densitiy in the right upper zone is present with clear evidence of volume loss (the trachea and mediastinum are pulled towards the right, and the hilum is elevated).
At the inferior margin of the central opacity there appears to be a lucent line.
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On the CT scan the right upper lobe density had the classical appearance of an aspergilloma: a well formed cavity with a central soft tissue attenuating rounded mass surrounded by an air crescent sign.
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Zoomed cropped images of the chest x-ray and CT elegantly show the cavity partially filled with debris/mass. Between the mass and the wall of the cavity a crescent of air is present (blue arrows).
Histology
Histology revealed fibrinous, putrid inflammation due to massive fungal infection with Aspergillus fumigatus.
Case Discussion
Aspergilloma is the most common manifestation of aspergillosis and is seen in patients with normal humoral immunity but with cavities in the lung (typically due to TB).
Fungal mycelia conglomerate in pre-formed cavities (e.g. cyts, caverns, bronchiectases) to a fungus ball (so called mycetoma).
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