Aspergilloma

Alternative names
Fungus ball; Mycetoma; Pulmonary aspergilloma

Definition
Pulmonary aspergilloma is a mass caused by a fungal infection that usually grows in pre-existing lung cavities. It can also appear in the brain, kidney, or other organs.

Causes, incidence, and risk factors

Aspergillomas are formed when the fungus aspergillus grows in a clump in a pre-existing pulmonary (lung) cavity or when the organism invades previously healthy tissue, causing an abscess.

Aspergillus is a common fungus. It grows on dead leaves, stored grain, bird droppings, compost piles, and other decaying vegetation. Pre-existing cavities in the lung may have been caused by a previous infection, such as histoplasmosis, tuberculosis, lung abscess, or by cystic fibrosis, sarcoidosis, or previous lung cancer. See also aspergillosis.

Symptoms
Many patients have no symptoms. When symptoms do develop, they can include:

• Cough
  
• Coughing up blood (seen in up to 75% of patients)
  
• Chest pain
  
• Shortness of breath
  
• Wheezing
  
• Unintentional weight loss
  
• Fever

• Chest x-ray
  
• Chest CT
  
• Sputum culture
  
• Bronchoscopy or bronchoscopy with lavage (BAL)
  
• Serum precipitans for aspergillus (blood test to detect antibodies to aspergillus)

Often, no treatment is necessary. However, if a patient coughs up blood, treatment may be required. In some cases, angiography (injection of dye into the blood vessels) may be used to locate the site of bleeding. The bleeding can then be stopped by shooting tiny pellets into the bleeding vessel. Surgery is another option to control bleeding, and is often the only choice if there is life-threatening bleeding.

Occasionally, antifungal medications such as itraconazole, voriconazole, or amphotericin B can be used.

Expectations (prognosis)

The outcome can be good in many patients, but depends on the severity and other factors. In select cases, surgery can be very effective when successful, but this surgery is complex and can have a high risk of serious complications. Many patients never develop symptoms and do not need any form of treatment.

Complications

• Progressive difficulty breathing
  
• Massive bleeding from the lung
  
• Spread of the infection (see acute invasive aspergillosis)

See your health care provider if you cough up blood, and mention any other symptoms that have developed.

Prevention

People who have had related lung infections or who have weakened immune systems should try to avoid environments where the aspergillus fungus is found.

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