A Case of Endobronchial Aspergilloma Coexisting With Lung Adenocarcinoma

Aspergillus species can cause a variety of lung diseases. Endobronchial aspergilloma is a rare clinical entity rarely encountered and often not included in the classification of Aspergillus lung diseases.  An 82-year-old woman presented to the outpatient setting with wheezing, shortness of breath, and productive cough. CT of the chest showed the presence of airway enlargement in a finger in glove pattern in the right upper lobe suggestive of allergic bronchopulmonary aspergillosis. Despite adequate treatment the abnormality persisted on repeat imaging. Bronchoscopy with biopsies eventually revealed the presence of hyphal elements suggestive of Aspergillus and poorly differentiated adenocarcinoma. Endobronchial aspergilloma is rare and not included in the classification of Aspergillus lung diseases. It is thought to result from airway colonization by Aspergillus species. Occasionally it can obscure an underlying lung carcinoma and thus delay the diagnosis. Diagnosis is made by pathological examination of biopsy specimens. Optimal treatment is not well established.