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Pulmonary aspergilloma simulating bronchogenic carcinoma
Olu Osinowo1, Abdul-Lateef Softah, Khader Zahrani
1Department of Surgery, Assir Central Hospital, Abha, Saudi Arabia. oluosi@hotmail.com
The Indian Journal of Chest Diseases & Allied Sciences
|April 10, 2003
Summary
Pulmonary aspergilloma, a fungal ball in lung cavities, often presents with life-threatening bleeding. This case highlights diagnostic challenges, differentiating it from lung cancer despite typical imaging findings.
Area of Science:
- Pulmonology
- Mycology
- Radiology
Background:
- Pulmonary aspergilloma arises from Aspergillus fumigatus colonization of pre-existing lung cavities.
- It commonly presents with severe, potentially fatal, hemoptysis.
- Radiological hallmarks include a ball-like structure within a cavity and an air crescent sign on imaging.
Observation:
- A 50-year-old male with a 25-year smoking history presented with hemoptysis.
- Radiographs showed a cavitary lesion with a ball-like structure and air crescent, raising suspicion for bronchogenic carcinoma.
- Initial biopsies and lavage were negative for malignancy and fungal elements.
Findings:
- Despite initial negative investigations, the patient underwent right thoracotomy.
- Surgical intervention confirmed and removed a pulmonary aspergilloma.
- The cavity was successfully obliterated using capitonnage with an uneventful recovery.
Implications:
- This case underscores the importance of considering pulmonary aspergilloma in patients with hemoptysis and cavitary lung lesions, even with atypical negative initial workups.
- It emphasizes the diagnostic challenges in differentiating aspergilloma from lung cancer based solely on imaging.
- Surgical management, including fungal ball removal and cavity obliteration, can be effective in resolving symptoms and preventing recurrence.