Pulmonary aspergillomas are caused by a fungal infection with Aspergillus fumigatus, Pseudallescheria boydii, Cryptococcus neoformans, Candida or Mucorales, presenting as a clump in pre-existing pulmonary cavities. The disease can also occur in the paranasal cavities, the brain, the kidneys and other organs. A. fumigatus typically grows in decaying vegetation and in bird feces. Patients with previous, recurring or persisting episodes of tuberculosis, coccidioidomycosis, cystic fibrosis, histoplasmosis, lung abscess, primary or metastatic lung carcinoma, a human immunodeficiency virus (HIV) infection or sarcoidosis often exhibit an increased pulmonary cavity count. The lesions are most frequently reported after tuberculosis episodes [1] [2] [3] [4] [5].

The symptoms can be chest pain, coughing, fatigue, fever, and sudden and unexpected weight loss. If coughing episodes are accompanied by blood-stained expectoration, immediate action is required, since this symptom may indicate an erosion of bronchial artery [2]. The involvement of paranasal cavities may present with symptoms similar to rhinosinusitis. In more complicated cases, inflammation symptoms conducive to aspergillosis can occur, which leads to additional symptoms like jaundice [1].

Aspergilloma growth is determined by aspergillus mycelial growth that seeds at the pulmonary cavity wall, gradually spreading into the cavity lumen. Mycelial layers will accumulate and create a sponge-like spherical conglomerate over time. The mass can also be mobile within the pulmonary cavity. The surrounding bronchioles may be affected by the aspergilloma's volume, potentially causing bronchiectasis [6].

• Fatigue

  A 68-year-old male with orthotopic heart transplantation presented with fatigue, cough, and dyspnea. [ncbi.nlm.nih.gov]

  Six years earlier, he had had a similar episode lasting 5 weeks, during which he had also had night sweats, weight loss, and fatigue. At that time, he was treated empirically for tuberculosis. [nejm.org]

  When symptoms do develop, they can include: Chest pain Cough Coughing up blood, which can be a life-threatening sign Fatigue Fever Unintentional weight loss Exams and Tests Your health care provider may suspect you have a fungal infection after x-rays [ufhealth.org]

  Symptoms lasting more than 3 months, usually including weight loss, fatigue, cough, coughing blood (haemoptysis) and breathlessness A blood test or tissue fluid test positive for Aspergillus species Aspergilloma An aspergilloma is a fungal mass caused [aspergillus.org.uk]

• Rales

  On physical examination, his basal oxygen saturation was 98%; ectoscopy showed that he was emaciated and pulmonary auscultation revealed basal crepitant rales, prominent in the left hemithorax. Laboratory test results were normal. [archbronconeumol.org]

• Abdominal Mass

  We report a previously healthy 8-year-old boy who presented to the hospital with a palpable abdominal mass, fever and abdominal pain. CT and MRI scans confirmed a large mass that was centered in the retroperitoneum. [ncbi.nlm.nih.gov]

• Dysphagia

  A 63-year-old male with chronic lymphoid leukemia was admitted for dyspnea, cough, weakness, and dysphagia. Chest CT and bronchoscopy showed a mass causing obstruction of the subglottic trachea and a fistula to the mediastinum. [ncbi.nlm.nih.gov]

• Dysphagia

  A 63-year-old male with chronic lymphoid leukemia was admitted for dyspnea, cough, weakness, and dysphagia. Chest CT and bronchoscopy showed a mass causing obstruction of the subglottic trachea and a fistula to the mediastinum. [ncbi.nlm.nih.gov]

• Gagging

  Moreover, there is no lung protection against endobronchial spillage during the period of induction of general anesthesia, when the cough reflex and gag reflex are absent. [ncbi.nlm.nih.gov]

Aspergilloma diagnosis requires the proof of a fungal infection and the specific localization of the lesion using standard imaging techniques. Most frequent procedures to be ordered are blood tests probing the existence of or an immune response against A. fumigatus as well as a sputum culture and a lung biopsy [1].

Computed tomography (CT) scans and plain radiography examinations will provide exact information about a potential aspergilloma. Radiographic investigations will only yield satisfying resolution in advanced stages [7]. CT results typically feature a central soft tissue within a pulmonary or paranasal cavity, which is surrounded by an air crescent (termed Monad sign). The observed conglomerate is usually spherical or ovoid and mobile upon repositioning of the patient [8].

Asymptomatic aspergillomas do not require treatment. They resolve spontaneously in ten percent of reported cases [9]. Symptomatic cases should be treated by (video-assisted) surgical removal or a lobectomy in the case of a pulmonary aspergilloma. Surgery complications range from excessive bleeding and wound dehiscence to respiratory insufficiency [10].

Recurrence can occur, most likely in the setting of pre-existing chronic aspergillosis. Patients should be checked for regrowth with annual radiographic examinations. Antifungal therapies have shown limited effect in experimental treatments of selected cases [11].

• Pulmonary Infiltrate

  No evidence of transient pulmonary infiltrates has been documented. A diagnosis of concomitant aspergilloma and ABPA was suspected. A wedge resection of the left upper lobe was performed ( fig. 2 ). [err.ersjournals.com]

  Pulmonary infiltrates do not respond to conventional antibiotics. [patient.info]

  Because it is uncommon, CNPA often remains unrecognized for weeks or months and can cause a progressive cavitary pulmonary infiltrate. [emedicine.medscape.com]

• Air Bronchogram

  Imaging prior to presentation demonstrated mediastinal lymphadenopathy and coalescent parenchymal alveolar opacities along with air bronchograms, suggestive of alveolar sarcoidosis. [ncbi.nlm.nih.gov]

• Aspergillus Fumigatus in the Sputum

  Sputum examination was negative for acid fast bacilli and culture yielded Aspergillus fumigatus from three sputum samples. With a diagnosis of pulmonary aspergilloma, the patient was referred to a higher center for further management. [atmph.org]

  Med Clin North Am 64:475–490 PubMed Google Scholar Pepys J, Riddell RW, Citron KM, Clayton YM, Short EI (1959) Clinical and immunologic significance of aspergillus fumigatus in the sputum. [link.springer.com]

• Hepatocellular Carcinoma

  The first patient was a 59-year-old white woman treated for a secondary lung nodule of an advanced hepatocellular carcinoma. [ncbi.nlm.nih.gov]

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