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

  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]

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

  The symptoms can be chest pain, coughing, fatigue, fever, and sudden and unexpected weight loss. [symptoma.com]

  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]

  They can experience unintended weight loss, a chronic cough that produces mucus, the coughing up of blood, fatigue, and shortness of breath. Less often, fever or night sweats can occur. [rarediseases.org]

• Wound Infection

  Table 4 Postoperative complications Table 4 Postoperative complications In group A, one patient (8.3%) had prolonged air leak after segmentectomy, another patients had a wound infection. [academic.oup.com]

  Infection tends to occur on the background of previous trauma, including wound infections at cannula and catheter sites and after venepuncture. A. flavus or Aspergillus terreus are the most frequent causes of primary infection. [patient.info]

  Aspergillus -related endocarditis and wound infections occur in the context of cardiac surgery. [emedicine.medscape.com]

• Chest Discomfort

  The aspergilloma was enlarging, with progression of the patient's symptoms of anorexia, cough, chest discomfort, and hemoptysis. Bronchoscopy revealed an airway leading into a cavity with a large fungal ball. Biopsy confirmed Aspergillus fumigatus. [ncbi.nlm.nih.gov]

  After 7 months, the patient presented with chest discomfort and was eventually diagnosed with renal cell carcinoma of the right kidney, with distant metastasis to the left eighth rib. He underwent right radical nephrectomy with chest wall resection. [spandidos-publications.com]

• Respiratory Insufficiency

  The major complications were residual pleural space (3.9%), prolonged air leak (3.1%), bronchopleural fistula (1.6%), excessive bleeding (1.6%), respiratory insufficiency (1.9%) and empyema (1.2%). No intraoperative deaths occurred. [ncbi.nlm.nih.gov]

  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. [symptoma.com]

  Described complications include residual pleural space, prolonged air leak, excessive bleeding, wound dehiscence and respiratory insufficiency. [aspergillus.org.uk]

  Patients with aspergilloma who present with hemoptysis are at risk of death due to massive hemoptysis and/or respiratory insufficiency caused by aspirated blood. [ctsnet.org]

• Respiratory Distress

  Patient was in respiratory distress. Chest X-ray showed consolidation of the entire left lung, which required ventilator support. A diagnosis of lung abscess with septicaemia was made. He succumbed to septicaemia. 3.  [ncbi.nlm.nih.gov]

  Acute respiratory distress syndrome. Bronchiectasis. Eosinophilic pneumonia. Granulomatosis with polyangiitis (Wegener's granulomatosis). Extrinsic allergic alveolitis. Other opportunistic infections in the immunocompromised. TB. Sarcoidosis. [patient.info]

  For the causes of death that were ascertained, pneumonia was the most common cause of death (five (55.5%) out of nine), complicated by acute respiratory distress syndrome in one patient. [erj.ersjournals.com]

  Conventional surgical complications including intraoperative and postoperative bleeding, prolonged air leakage, indicating secondary thoracoplasty and respiratory distress, are the prerogative of patients with complex aspergilloma. [bmcsurg.biomedcentral.com]

• 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]

• Chest Pain

  Clinical manifestations of pulmonary aspergilloma and pulmonary actinomycosis include chronic cough, fever, chest pain, haemoptysis and other pathologies, but some patients may be asymptomatic. [ncbi.nlm.nih.gov]

  He showed a satisfactory response to ATT with a resolution of fever, cough, hemoptysis, chest pain, and gained weight. He gained 7 kg weight on ATT. [jacpjournal.org]

  Common presenting complaints are Haemoptysis, Dyspnoea, Cough, Chest pain and Fever. [scopemed.org]

  The symptoms can be chest pain, coughing, fatigue, fever, and sudden and unexpected weight loss. [symptoma.com]

• Thrombosis

  Although common long-term complications of these devices, such as infection and thrombosis, have been widely reported, venous-airway fistula due to port placement is an extremely rare and poorly understood complication. [ncbi.nlm.nih.gov]

  The cerebral vasculature can be involved by mycotic aneurysms or intra-arterial thrombosis. [jpgmonline.com]

  Large venous sinus thrombosis is the common cause of presentation in fungal infection of CNS. [annalsofian.org]

  The massive vascular thrombosis explains the strictly localized character of the aspergilloma. Access options Buy single article Instant access to the full article PDF. 39,95 € Price includes VAT (Finland) Bibliographie Austwick P. K. C. 1962. [link.springer.com]

  Patients may have necrosing cutaneous lesions overlying the nose or sinuses, palatal or gingival ulcerations, signs of cavernous sinus thrombosis, or pulmonary or disseminated lesions. [merckmanuals.com]

• Jaundice

  In more complicated cases, inflammation symptoms conducive to aspergillosis can occur, which leads to additional symptoms like jaundice. [symptoma.com]

  Pallor was present but there was no jaundice, cyanosis or pretibial edema. Respiratory System examination revealed bronchial breathing in left infraclavicular area. Cardiovascular, Abdominal and Nervous System examinations were normal. [omicsonline.org]

• Sweating

  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]

  Description A 42-year-old man presented with productive cough, haemoptysis, night sweating, temperature 39°C, asthenia and weight loss of 35 kg in 12 months. He had a 25-year history of smoking (40 cigarettes/day) and alcoholism. [casereports.bmj.com]

  He denied fever, night sweats, weight loss, and any recent contact with a known tuberculosis case. A prior treatment with a broad-spectrum antibiotic had not been successful. [journals.plos.org]

  He also reported night sweats associated with sporadic chills in the past 2 months, and use of amoxicillin for 7 days without symptom improvement. The patient denied fever and other symptoms. [archbronconeumol.org]

• Night Sweats

  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]

  Description A 42-year-old man presented with productive cough, haemoptysis, night sweating, temperature 39°C, asthenia and weight loss of 35 kg in 12 months. He had a 25-year history of smoking (40 cigarettes/day) and alcoholism. [casereports.bmj.com]

  He denied fever, night sweats, weight loss, and any recent contact with a known tuberculosis case. A prior treatment with a broad-spectrum antibiotic had not been successful. [journals.plos.org]

  He also reported night sweats associated with sporadic chills in the past 2 months, and use of amoxicillin for 7 days without symptom improvement. The patient denied fever and other symptoms. [archbronconeumol.org]

• Hunger

  Well Photo Credit Illustration by Celia Jacobs Outrunning Hunger Intense exercise may change the way certain neurons influence our appetite and metabolism. [nytimes.com]

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]

  CXR may show nodules, cavitary lesions or pulmonary infiltrates. [patient.info]

• Aspergillus Fumigatus in the Sputum

  Clinical and inmunologic significance of Aspergillus fumigatus in the sputum. Amer. Rev. Resp. Dis., 80 (1959), pp. 167 [9.] F. Palacio Caso, B. Cavanillas Batalla. Aspergiloma bronquial. Rev. Clin. Esp., 88 (1963), pp. 275 [10.] P. Hertzog, L. [archbronconeumol.org]

  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]

As for treatment, surgery was performed in 20 cases (55%), bronchial artery embolization without surgical treatment was done in 4 cases (12%), and 12 cases (33%) received conservative medical treatment only. [kjim.org]

Surgical treatment with lung resection has traditionally been the treatment of choice for pulmonary cavities containing aspergillomas that cause hemoptysis. [ncbi.nlm.nih.gov]

Our long-term follow-up study also revealed a favorable prognosis. Based on this experience, we suggest caspofungin acetate as first-line therapy for treatment plans of liver aspergilloma. [ncbi.nlm.nih.gov]

In many, the prognosis is good. [dovemed.com]

Pulmonary aspergilloma: analysis of prognosis in relation to symptoms and treatment. J Thorac Cardiovasc Surg 2009; 138: 820-825. Okubo K, Kobayashi M, Morikawa H, Hayatsu E, Ueno Y. [termedia.pl]

No other etiology of sinus RAI uptake has been mentioned to date. We report five cases of DTC patients with sinus RAI uptake on post-RAI scintigraphy. [ncbi.nlm.nih.gov]

After this detailed examination, the etiologic setting was assigned to each case. [ijpmonline.org]

Subsequently, we systematically reviewed 22 confirmed cases of pulmonary hydatid cyst and aspergilloma during a period of 19 years (1995-2014) and discussed the epidemiology, clinical features, and treatment of this disease. [ncbi.nlm.nih.gov]

GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol. 2011; 64 (3):380–2. https://doi.org/10.1016/j.jclinepi.2010.09.011 3. Panackal AA, Li H, Kontoyiannis DP, et al. [revistasdigitales.uniboyaca.edu.co]

Aspergilloma Epidemiology Aspergilloma has a variable prevalence depending on the amount of cavitating lung disease affecting a population. [patient.info]

Laboratory and Epidemiology Communications Anti-Fungal Chemotherapy for Symptomatic Pulmonary Aspergilloma Akihiko Kawana*, Yasuhiro Yamauchi and Koichiro Kudo Department of Pulmonology, International Medical Center of Japan, Toyama 1-21-1, Shinjuku-ku [www0.nih.go.jp]

Pathophysiology Invasive infections are usually acquired by inhalation of spores or, occasionally, by direct invasion through damaged skin. [merckmanuals.com]

Keywords : Aspergilloma ; Pulmonary tuberculosis ; Hemoptysis INTRODUCTION Pulmonary aspergillosis, which is caused by Aspergillus fumigatus, can be classified into 5 categories according to its pathophysiology, clinical manifestation, and treatment modality [kjim.org]

Such an event appears plausible theoretically because embolization cuts off nutrition to the fungal ball, which feeds out of the cavity walls it dwells in; however, it does not concur with the known pathophysiology of fungal ball that they occur because [ijri.org]

Keywords: Aspergilloma, Pulmonary tuberculosis, Hemoptysis INTRODUCTION Pulmonary aspergillosis, which is caused by Aspergillus fumigatus, can be classified into 5 categories according to its pathophysiology, clinical manifestation, and treatment modality [ncbi.nlm.nih.gov]

CONCLUSIONS: An early diagnosis of ISSA, although not easy, is important to prevent complications arising from extensions of these lesions beyond the sphenoid sinus. [ncbi.nlm.nih.gov]

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