Pulmonary aspergilloma (mycetoma)

Answer 1

Definition

Pulmonary aspergilloma is a mass caused by a fungal infection that usually grows in lung cavities. It can also appear in the brain, kidney, or other organs.

Alternative Names

Fungus ball; Mycetoma; Aspergilloma

Causes, incidence, and risk factors

Aspergillomas are formed when the fungus aspergillusgrows in a clump in a lung cavity, or invades previously healthy tissue, causing an abscess.

Aspergillus is a common fungus. It grows on dead leaves, stored grain, bird droppings, compost piles, and other decaying vegetation. Cavities in the lung may have been caused by:

• Coccidiomycosis
• Cystic fibrosis
• Histoplasmosis
• Lung abscess
• Lung cancer
• Sarcoidosis
• Tuberculosis

See also: Aspergillosis

Symptoms

Many patients have no symptoms. When symptoms do develop, they can include:

• Chest pain
• Cough
• Coughing up blood (seen in up to 75% of patients)
• Fever
• Malaise
• Unintentional weight loss
• Shortness of breath
• Wheezing

Signs and tests

• Blood test for presence of aspergillus in the body (galactomannan)
• Blood test to detect antibodies to aspergillus (serum precipitins for aspergillus)
• Bronchoscopy or bronchoscopy with lavage (BAL)
• Chest CT
• Chest x-ray
• Sputum culture

Treatment

Often, no treatment is needed, unless you are coughing up blood.

In some cases, injecting dye into the blood vessels (angiography) may be used to find the site of bleeding. The bleeding can then be stopped by shooting tiny pellets into the bleeding vessel. Surgery is another option to control bleeding, and is often the only choice if there is life-threatening bleeding.

Occasionally, antifungal medications may be used.

Expectations (prognosis)

The outcome can be good in many patients. However, it depends on the severity of the condition and other factors.

In some people, surgery can be very effective when it is successful, but this surgery is complex and can have a high risk of serious complications.

Many patients never develop symptoms and do not need any form of treatment.

Complications

• Difficulty breathing that gets worse
• Massive bleeding from the lung
• Spread of the infection (see acute invasive aspergillosis)

Calling your health care provider

See your health care provider if you cough up blood, and mention any other symptoms that have developed.

Prevention

People who have had related lung infections or who have weakened immune systems should try to avoid environments where the aspergillus fungus is found.

References

Patterson TF. Aspergillus species. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005: chap 256.