Developing Aspergilloma - As Seen On Chest X ray

A 43 years old male presented with a history of cough, fever and weight loss with loss of appetite since two months. His Chest X ray is shown below:

X-ray chest shows a right mid zone cavity with thick irregular wall with non-homogeneous shadowing due to an irregular sponge work filling the cavity with intervening air spaces.

Comments And Explanation:
Superinfection with Aspergillus generally occurs in a pre-existing cavity (tuberculous or bronchiectasis) in immune-compromised patient.
Initially, the aspergilloma appears as an irregular spongework filling the cavity with intervening air spaces (as seen in the above X ray). Presumably this appearance reflects the presence of irregular fonds of fungal mycelia mixed with residual intracavity air. Furthermore, thickening of the wall of the cavity can be a finding of superimposed fungal infection well prior to development of a fungal ball as has been demonstrated in this case.


Diagnosis: Developing aspergilloma

Clinical Discussion:

• A fungus ball or mycetoma caused by one of the Aspergillus species which infect humans. Among the common varieties are A. fumigatus and A. niger. 
• Aspergillomas are collections of fungal hyphae and cellular debris which occur inside a pre-existing cavity as a saprophytic growth. Initially mycetomas may produce wall thickening of the cavity wall. Fungal growth finally results in a free-moving rounded mass which usually does not fill the cavity completely. 
• Aspergillomas are typically detected on chest radiographs as an incidental finding or are discovered as a cause of hemoptysis. If the mass begins to fill the entire cavity an air crescent sign may be seen on chest films. Calcification and fluid levels are rare.