Presentation
Known case of pulmonary tuberculosis. Now presents with chest pain and hemoptysis.
Patient Data
Fibrotic changes, bronchiectasis and volume loss are seen in both upper lobes.
A large cavity is seen in the right upper lobe. A dependent round soft tissue intracavitary body is seen within the cavity having a Monod sign.
Both lower lobes are hyper-inflated.
Case Discussion
The imaging features suggest post-tuberculous fibrosis, cavitation and dependent fungal ball (aspergilloma) within the cavity with Monod sign.
Pulmonary aspergillosis is commonly associated with old tuberculous cavities and is more common in immunocompromised patients.
The fungal ball consists of fungal hyphae, mucus and cellular debris.
Pulmonary aspergilloma can also grow within bronchiectatic bronchi, bronchogenic cysts and pneumatoceles.
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