Presentation
Chronic cough and shortness of breath.
Patient Data
A pulmonary cavity in the left upper zone involving the posterior segment of left upper lobe and apical segment of left lower lobe. It is filled with soft tissue density surrounded by an air crescent at its apex.
Focal areas of nodular opacities with tree-in-bud appearance, areas of ground-glass opacities, traction bronchiectasis, and consolidative lesions some of them show central cavitation in both lungs.
Bilateral apical scarring with calcifications.
No pleural effusion. No significant mediastinal lymphadenopathy.
Case Discussion
Diagnosis was made based on the characteristic imaging appearance of ball-like structure in a pre-existing pulmonary cavity surrounded by a crescent of air (air meniscus sign). One of the risk factors for aspergilloma is the presence of underlying cavitary lung disease. TB is the most common predisposing structural lung disease for aspergilloma.
Focal areas of nodular opacities with tree-in-bud appearance, ground-glass opacities and consolidations in both lungs, raising the possibility of reactivation tuberculosis with endobronchial spread.
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