Aspergilloma

(aka Aspergillus Mycetoma)

Physiology

  • Fungus ball
  • Usually develop within a cavity, from prior TB, Sarcoidosis, bronchiectasis

Diagnosis

  • Sputum GS/Cult+Sens:
    • Stain or culture may be positive for Aspergillus
  • CXR/Chest CT Pattern:
    • Round or Oval Lung Nodule:
    • Location: upper-lobe predilection
    • Calcification: absent
    • Almost always found within a cavity (“crescent” sign: with ball in cavity)
    • Fungus ball may be mobile with patient movement
  • Aspergillus Serum Precipitins: >95% sensitivity for Aspergilloma

Clinical Presentations

  • Asymptomatic: in most cases
  • Hemoptysis
    • May be massive (100-600 ml/24h period)

Treatment

  • Surgical Resection: treatment of choice
    • Indicated for significant hemoptysis
    • Hemoptysis may recur after surgery, due to presence of collateral channels that revascularize the wall of the cavity
  • IR Bronchial Artery Embolization: indicated for non-surgical candidates
  • Intracavitary Ampho, Sodium Iodide, or Potassium Iodide: may be effective in some non-surgical candidates
  • Systemic Antifungals: may be effective in some non-surgical candidates

References

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