Diagnosis of aspergilloma in a pleural cavity (persistent pneumothorax) using classic imaging methods

Abstract

The diagnosis of pulmonary aspergillosis is based on serum-analysis, as well as histological and microbiological analysis of bronchial lavage and transbronchial biopsies. When Aspergillus develops within a preformed cavity, however, these tests are likely to be negative. In this situation, classic imaging techniques such as chest X-ray and high resolution-computed tomography (HR-CT) can be of great diagnostic use. We here describe the case of a 62-year-old woman with a history of breast cancer and subsequent ablation of the left breast and radiotherapy. The case demonstrates an example of a pleuropulmonary aspergilloma, in which sero- and micro-biological detection failed. Thorax HR-CT exhibited the cavity, a small persistent pneumothorax, partially filled by an oval density. This density clearly dislocated according to gravity following a positional change of the patient from supine to prone. The density thus revealed mobility which was typical of aspergilloma. Following excision, this diagnosis was confirmed. A density within a cavity may be differentiated by its mobility from differential diagnoses such as lung cancer which would not be expected to exhibit mobility.

Bola fúngica por Aspergillus fumigatus em cavidade pleural

“…(1,7) In rare cases, an aspergilloma can be located in the pleural space, being usually subsequent to surgical complications or concomitant with the presence of a bronchopleural fistula. (10)(11)(12)(13)(14)(15)(16)(17)(18) The objective of the present study was to report and document cases of patients with pleural aspergilloma caused by Aspergillus fumigatus, determining the profile of those patients, and therefore to assist in raising clinical suspicion.…”