[Pulmonary aspergillosis with air-fluid level in a cavity]

We experienced 17 cases of pulmonary aspergillosis with air-fluid level in a cavity. The incidence of this phenomenon was 39% in 44 patients who were diagnosed as having pulmonary aspergillosis during the period from 1983 to 1991 at Yaizu Municipal Hospital. There were two clinical patterns: primary air-fluid type and secondary air-fluid type. Primary air-fluid type disease began with cavitation with an air-fluid level. Our 14 cases of this type had severe symptoms and inflammatory reaction. In secondary air-fluid type, the fungus ball disappeared and an air-fluid level appeared in a cavity during treatment. Our 3 cases of this type had only mild cough and sputum. The fluid disappeared later in two of these three cases. Some cases of primary air-fluid type changed to fungus ball type or productive aspergilloma on the inner wall of a cavity. Primary air-fluid type thus seems to represent incipient pulmonary aspergilloma, and to be important for early diagnosis and treatment. Of the immunological tests, precipitins to Aspergillus fumigatus proved most useful for early diagnosis.