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Aspergillus-related lung mass masquerading as a lung tumour
Saifullah Mohamed1, Akshay J Patel1,2, A Darr1
1Department of Thoracic Surgery, Heartland's Hospital, Birmingham, UK.
Abstract:
Aspergillus is a common environmental pathogen. However, clinically significant disease only occurs in a small proportion of patients. Although rare in its occurrence, it remains a considerable cause of morbidity and mortality in certain cohorts of patients. We describe a rare case of Aspergillus disease masquerading as a primary lung malignancy. Computer tomography pulmonary angiogram scan demonstrated a right upper lobe 8 x 6.5 cm soft-tissue lesion. Positron emission tomography CT demonstrated this lesion to be intensely fluorodeoxyglucose avid. Initial bronchoscopy demonstrated occluded subsegmental right upper lobe bronchus with white friable material. Follow-up bronchoscopy demonstrated evidence of a previous inflammatory process with cavitation and destruction of sub-lobar bronchial tree. Serial chest radiographs demonstrated almost complete resolution of the right upper lobe mass. Thus, this presentation of an Aspergillus-related lung mass masquerading as a primary lung malignancy provided several important learning points pertaining to diagnosis and ensuing management.
Insights
This case study highlights a rare instance of Aspergillus infection mimicking lung cancer. Prompt diagnosis and management led to the resolution of the Aspergillus-related lung mass.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Aspergillus is a common environmental mold, but invasive disease is rare.
- Clinically significant Aspergillus infections can cause substantial morbidity and mortality in susceptible individuals.
Observation:
- A patient presented with a large, metabolically active lung lesion suspicious for malignancy.
- Imaging revealed a right upper lobe mass with bronchial obstruction by fungal material.
- Resolution of the mass was observed after treatment, indicating an infectious etiology.
Findings:
- The case demonstrates Aspergillus disease presenting as a primary lung malignancy.
- Diagnostic challenges included differentiating fungal infection from lung cancer based on initial imaging.
- Successful management involved addressing the Aspergillus infection, leading to lesion resolution.
Implications:
- This case underscores the importance of considering fungal infections in the differential diagnosis of lung masses.
- Early and accurate diagnosis is crucial for appropriate treatment and improved patient outcomes.
- Further research into distinguishing Aspergillus lung disease from malignancy is warranted.
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