[Pulmonary aspergilloma clearly demonstrated by digital subtraction bronchography]

A 69-year-old woman was admitted because of persistent productive cough, low-grade fever and abnormal pulmonary infiltrates. Chest roentgenograms revealed right pulmonary cavitary lesions and infiltrates in both upper pulmonary fields. Digital subtraction bronchography (DSBG) was performed to detect for the presence of pulmonary cavitary lesions. Double-contrast DSBG images clearly revealed marked bronchiectasis in the right pulmonary cavity with aspergilloma in the cavitary lesions. Aspergilloma was not obvious in routine chest roentgenograms and computed tomograms. Asperillus fumigatus was cultured from sputum materials, and aspergilloma of the pulmonary cavity was clinically diagnosed. The infiltrative lesions were thought to be associated with invasive aspergillosis because the patient exhibited persistent low-grade fever and positive inflammatory reactions. Anti-fungal chemotherapy was highly effective in treating these lesions. DSBG is a new, less-invasive bronchographic technique for the evaluation of bronchial trees, and in this case proved useful for the detection of small aspergilloma in pulmonary cavities.