The patient's blood-stained thick sputum is shown B. She had tuberculosis in 1955 treated with streptomyin for 1 year. She developed a severe cough with haemoptysis in 2003 and responded to itraconazole treatment given orally. In january 2006 she deteriorated with thick purulent sputum and some hameoptysis, and this has continued intermittently since then, despite itraconazole. Her serum contains a high titre of Aspergillus precipitating antibody.
Her chest X-ray shows almost complete fibrosis of the right upper lobe with pleural thickening and one or more large cavities filled with material likely to represent an aspergilloma.