aspergillomas

Aspergilloma, also known as a fungus ball, is a non-invasive colonization of a pre-existing cavity in the lung by fungi, most commonly *Aspergillus fumigatus*. These cavities can result from various conditions, including tuberculosis, sarcoidosis, lung abscesses, or cystic fibrosis. The aspergilloma itself is a dense mass of fungal hyphae, often mixed with mucus, fibrin, and cellular debris.

Clinically, aspergillomas can be asymptomatic and discovered incidentally on chest imaging. When symptoms do occur, they are often chronic and non-specific, including cough, hemoptysis (coughing up blood), chest pain, and dyspnea (shortness of breath). Hemoptysis is a significant symptom and can range from mild streaking to life-threatening massive bleeding.

Diagnosis typically involves chest imaging such as a chest X-ray or CT scan, which can reveal a characteristic rounded opacity within a cavity, often with a crescent of air surrounding it (air-crescent sign). Serological tests for antibodies against *Aspergillus* may be positive but are not definitive as they can also be present in invasive aspergillosis. Fungal cultures from sputum are often negative because the fungus is not actively growing and invading tissue.

Treatment is generally recommended for symptomatic patients or those with a history of significant hemoptysis, due to the risk of severe bleeding. Medical management with antifungal medications, such as itraconazole or voriconazole, is often the first line of therapy. However, medical treatment has limited efficacy in eradicating the fungus ball itself. Surgical resection of the aspergilloma is often considered the most definitive treatment, particularly for recurrent or severe hemoptysis. Management decisions are individualized based on the patient's symptoms, overall health, and the specific characteristics of the aspergilloma.

---