Case 076: Suspicious lung nodule which was resected and showed an aspergilloma on histology- diagnosis CPA
Summary:

A 54 year old man presented with a cough, chest pain and shortness of breath. A chest x- ray showed right upper lobe shadowing. Investigations, including a PET/CT scan suggested carcinoma of the lung. He underwent an apical resection and histology showed bullae in the lung with one containing necrotic material and conidial heads consistent with Aspergillus.

Comments:

Diagnosis:
A nodular/spiculated lesion in the right lung pre-operatively, was most consistent with carcinoma. Histology showed a bulla containing a filamentous fungus most consistent with Aspergillus. Cultures were not taken. An aspergilloma in a cavity (bulla) was provisionally diagnosed, but multiple cavities on CT scan and positive Aspergillus IgG antibodies indicated CPA.

Response to antifungal therapy:
Patient was given long-term itraconazole with a favourable response.

Outcome:
He is at risk for recurrence, as his emphysema is severe. Long term follow up of his chest radiograph and Aspergillus antibodies are necessary, assuming these are positive.

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