This is a 55-year-old lady presented initially with shortness of breath. A chest x-ray was requested demonstrated a cavitary lesion at the apex of the right lung. Previous CT guided true cut needle biopsy from the solid component of this lesion done upon initial presentation proved that it is a non-malignant lesion. Two years later presented with fever and cough when sputum sample for cytology was requested showed the following.

Sputum Cytology Report:

Few aggregates of neutrophils were seen, associated with branching septate fungal hyphae, confirmed by silver stain. Their morphology is consistent with  Aspergillus species. Negative for malignant cells.

Diagnosis of invasive aspergillosis was made and the patient has been managed accordingly.