An aspergilloma is a non-invasive, spherical mass of fungal hyphae, mucus and cellular debris that commonly grows in pulmonary or paranasal cavities. It occurs more frequently in patients with structurally abnormal lungs and is asymptomatic in most cases. Standard radiographic methods can diagnose this condition. In few cases, hemoptysis may occur. In such a setting, surgical removal and subsequent control examinations are imperative.
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     .
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 . 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 .
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 .
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 .
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 . 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 .
Asymptomatic aspergillomas do not require treatment. They resolve spontaneously in ten percent of reported cases . 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 .
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 .