Bilateral Apical Fungal Ball of Post Tubercular Fibrocavity of Lung

Abstract

A 60 year female, housewife, presented with recurrent cough, breathlessness, hemoptysis from the past 20 yrs. Hemoptysis turned severe since 6 yrs., along with expectaration. Her family history is not significant. Patient has typical clubbing of all digits. On examination of chest, there is B/L wasting of muscles and increased hollowness of apical chest, trachea in midline, apical impulse normal in 5 th left ICS. Vocal tactile fremitus decreased on B/L supra and infraclavicular areas, impaired note present. Fine mid inspiratory crepts, not altered with cough. No post tussive suction noted. Bronchial breath sounds present with decreased VR, due to a fungal ball occupying B/L apical fibrocavities. Patient maintaining normal oxygen saturation, but during bouts of Hemoptysis, there is a fall in oxygen saturation, along with breathlessness. Sputum for afb negative at RNTCP (1) culture of fungal elements positive. FOB BAL fluid sent for culture. Aspergillus fumigates is isolated. On Trendelenberg position, CXR revealed B/L apical fibrocavity with fungal ball. HRCT revealed B/L apical fibrocavity with fungal ball with air crescent sign positive on both sides.