Aspergilloma on background pulmonary fibrosis
Chronic cough and shortness of breath.
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There is diffuse honeycombing seen with an apicobasal gradient, most severe in the right base associated with traction bronchiectasis. In the less affected apices, there is subpleural reticular opacity. Throughout both lungs, there is diffuse ground glass opacity, more prominent in the bases than apices. Within the right base is a mobile 3.9cm oval opacity in a cystic space compatible with an aspergilloma.
There are features of usual interstitial pneumonia (UIP) pattern throughout both lungs with severe cystic change in the right base with a superimposed aspergilloma. However, there is also diffuse ground glass opacity, which is not typical for UIP. The patient had a history on the referral of probable UIP and recent methotrexate pneumonitis and the combination of these likely explains the imaging findings.