(aka Aspergillus Mycetoma)

Physiology

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

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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

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Clinical Presentations

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

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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

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References

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