Tuberc Respir Dis.  1985 Sep;32(3):211-215. 10.4046/trd.1985.32.3.211.

Solitary Pulmonary Nodule with Recurrent Hemoptysis

• KMID: 2528740
• DOI: http://doi.org/10.4046/trd.1985.32.3.211

Abstract

A mycetoma is a mass of intertwinged fungal hyphae within a pulmonary cavity. It may be the result of colonization of Candida or by other fungal species. However the most common invader is Aspergillus. The most common underlying causes of the cavity are tuberculosis and then sarcoidosis, bronchiectasis, emphysematous bullae, bronchial cyst, pulmonary infarct, lung abscess, hematologic malignancies and prolonged use of corticosteroid or antibiotics. Chest tomogram taken in the upright position provide the best in subjects of the Aspergilloma and of the surrounding air-crescent. The major clinical problem associated with Aspergilloma is pulmonary hemorrhage. Surgical excision is the only effective treatment and should be utilized after a second bout of severe hemorrhage in the patient who has unilateral diseases with a single obvious Aspergilloma, and who has no major impairment of pulmonary function. A 28-year-old housewife was admitted with many bouts of mild to moderate amount of hemoptysis. There was no history of previous bronchopulmonary disease and any clinical and laboratory evidence of active pulmonary tuberculosis. Roentgenogram of her chest showed ovoid homogenous mass without cavity or air-crescent in left upper lobe. Sputum examinations for tubercle bacilli, malignant cell and Aspergillus culture were all negative. Serologic test(immunodiffusion method) for Aspergillosis was negative. Anti-tuberculous therapeutic trial yielded no alteration of the symptoms and roentgenographic feature. Left upper lobectomy was performed, and the specimen removed was found to contain 2 x 3 cm sized ovoid mass surrounded by lung parenchyme. Its cross section showed cheeze-like material. Microscopic examination revealed fungal mycelia of Aspergillus species.