Introduction: An air filled lesion can be a diagnostic dilemma and a careful investigation must be following to clarity any underlining pathology.

Our objective is to underline the place of FAST (focus assessment by sonography for trauma) ultrasonography (US) in the investigation of blunt abdominal trauma. We retrospectively examined the ultrasound findings in 1,999 haemodynamically stable adult patients. These people were admitted to the emergency room (ER) for possible blunt abdominal trauma. All were stable at admission and a FAST ultrasound examination was made. Initial findings were compared with the clinical course after at least 24 h of observation time and CT results. Among the 1,999 US examinations, abnormalities were found in 109 (5.5%) cases. Among them, 102 had free peritoneal fluid, and in 58 examinations, ruptures, lacerations or haematomas were demonstrated. Despite its limitations, such as in cases involving uncooperative patients, excessive bowel gas, obesity and empty bladder, the FAST technique seems to be an accurate method to evaluate the possibility of abdominal blunt trauma in stable patients. Because of the high negative predictive value of the FAST technique in stable patients with blunt abdominal trauma, we recommend that a stable patient with negative ultrasound results at admission remain under close observation for at least 12 or preferably 24 h before being discharged.

A 51-year-old man, with a history of severe COPD and bilateral pneumothorax, who was under treatment for pulmonary tuberculosis due to mycobacterium avium, was admitted due to high-grade fever, weight loss, cough, and production of purulent sputum, for almost one month without any special improvement despite adequate antibiotics treatment in outpatient setting. A CT scan revealed multiple consolidations, fibrosis, scaring, and cavitary lesions in both upper lobes with newly shadows which were fungus balls inside them. Aspergillus flavius was isolated in three sputum samples, a diagnosis of chronic cavitary pulmonary aspergillosis was made, and treatment with intravenous amphotericin B was started. An initially clinical improvement was noted, and a first episode of minor hemoptysis was treated with conservative measures. Unfortunately a second major episode of hemoptysis occurred and he died almost immediately. Aspergilloma is defined as the presence of a fungus ball inside a preexisting pulmonary cavity or dilated airway and is one of the clinical conditions associated with the clinical spectrum of pulmonary colonization. Tuberculosis is the most common underling disease. Hemoptysis is the most common symptom. Antifungal antibiotics, surgical interventions, bronchial arteries embolization, and intracavity infusion of antibiotics have been proposed without always adequate sufficiency.

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