Endobronchial aspergilloma: A case report and literature review

Abstract

Abstract. The present study aimed to investigate the clinical and radiological characteristics in addition to the bronchoscopic appearance in patients with endobronchial aspergilloma (EBA). Clinical and radiological characteristics were analyzed alongside the bronchoscopic appearance in 17 patients with EBA diagnosed by bronchoscopy with histological examination. The present study assessed the relevant literature and 13 males and 4 females were included in the comparison, with a median age of 59. Associated diseases included 8 previous diagnoses of pulmonary tuberculosis (47.6%), 4 previous diagnoses lung cancer (23.5%), 1 pulmonary resection (5.9%) and 1 bronchial foreign body (5.9%). The primary symptom was hemoptysis (9/17, 53%). Chest computed tomography (CT) indicated a markedly higher incidence of aspergillosis lesion in the left lung (13/17; 76.5%) compared with the right lung (4/17; 23.5%). CT manifestation included space occupying disease in 10 patients (58.8%), aspergilloma in 3 patients (17.6%), pneumonic consolidation in 2 patients (11.8%) and ground glass opacity in 1 patient (5.9%). Bronchoscopy examination identified masses in all 17 patients' bronchial lumen and 15 patients had endobronchial obstruction by necrotic material. The case presented in the current study demonstrated the merits of combining bronchosopic intervention with voriconazole. The dominant symptom of EBA was hemoptysis. Chest CT demonstrated that aspergillosis lesions were more frequently identified in the left lung compared with the right. EBA often occurs in individuals with underlying lung diseases, which cause lumen structural change or bronchial obstruction. EBA may be clearly diagnosed by bronchoscopy biopsy, although the potential for a co-exististing tumor requires consideration. Bronchoscopic intervention and anti-fungal therapy may have an advantage in the effective treatment of patients with EBA. IntroductionAspergillus spp. are a ubiquitous fungus in the environment, which are easily identified in soil, water and various types of decomposing organic matter (1). Inhalation of Aspergillus spores causes pulmonary aspergillosis, which is the most common form of aspergillus filamentous fungal infection, and is often diagnosed in patients with immune deficiencies or systemic diseases (2). Aspergillosis is currently divided into the following categories (3): i) Invasive pulmonary aspergillosis (IPA), a severe disease and major cause of mortality in severely immunocompromised patients; ii) chronic necrotizing aspergillosis (CNA), presents as a locally invasive disease and is observed primarily in patients who are mildly immunocompromised or have chronic lung disease; and iii) allergic bronchopulmonary aspergillosis (ABPA), a non-invasive hypersensitivity pulmonary disease caused by Aspergillus. Aspergilloma is a fungus ball that develops in a pre-existing cavity in lung parenchyma, which may be easily detected by X-ray and computed tomography (CT) scans (3). In addition, a novel category of aspergillosis with semi-invasive f...

Beyond the skin – A rare case of primary pulmonary melanoma and endobronchial aspergilloma

“…A second bronchoscopy must be performed to evaluate the clinical response to treatment. Optimal treatment and duration is not yet established [ 5 , 6 ].…”