Pulmonary aspergilloma

Lungs — The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

Also known as: Fungus ball, Mycetoma or Aspergilloma

Definition

Pulmonary aspergilloma is a mass caused by a fungal infection that usually grows in 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 lung cavity, or 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. Cavities in the lung may have been caused by:

Symptoms

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

Signs and tests

Blood test for presence of aspergillus in the body (galactomannan)
Blood test to detect antibodies to aspergillus (serum precipitins for aspergillus)
Bronchoscopy or bronchoscopy with lavage
Chest CT
Chest x-ray
Sputum culture

Treatment

Many patients never develop symptoms. Often, no treatment is needed, unless you are coughing up blood.

Occasionally, antifungal medications may be used.

Sometimes, injecting dye into the blood vessels (angiography) may be used to find the site of bleeding. The bleeding is stopped by shooting tiny pellets into the bleeding vessel.

Surgery is often the only choice if there is life-threatening bleeding.

Expectations (prognosis)

The outcome can be good in many patients. However, it depends on the severity of the condition and your overall health.

Surgery may be very successful in some cases, but it is complex and can have a high risk of serious complications.

Complications

Difficulty breathing that gets worse
Massive bleeding from the lung
Spread of the infection (see acute invasive aspergillosis)

Calling your health care provider

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.

References

Patterson TF. Aspergillus species. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005: chap 256.

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Review date:: September 15, 2010
Reviewed by:: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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