Bronchoscopic Removal of Aspergilloma in a 26-Year-Old Man

A 26-year-old man with recurrent pulmonary tuberculosis and prior left pneumonectomy presented with progressive dyspnea. Chest computed tomography revealed a cavitary fungal ball in the right upper lobe, and elevated Aspergillus fumigatus IgG confirmed chronic pulmonary aspergillosis. Despite oral voriconazole, the cavity enlarged and surgery was contraindicated due to severely limited lung function. Bronchoscopic removal was performed using an ultrathin bronchoscope, two flexible bronchoscopes of increasing diameter, biopsy forceps, a Fogarty catheter and suction. The friable fungal mass was fragmented and completely extracted over two sessions. Histopathology and culture confirmed Aspergillus fumigatus. At 18-month follow-up, imaging showed complete resolution of the fungal ball with cavity-wall thinning and no recurrence, accompanied by symptomatic improvement and a 45% decline in Aspergillus fumigatus IgG. Bronchoscopic removal may represent a feasible minimally invasive option in carefully selected, medically refractory, surgically ineligible patients, though durability remains unproven from a single case.