Aspergilloma

Presenter: Clerk 鄭安祐

Supervisor: 林重榮主任、田光昕醫師
Patient's profile
• 18712362 黃 OO 43F

• CC: fever up to 38.3 °C within two days.

(2010/9/28)

• Underlying disease: left breast infiltrating

ductal carcinoma, T2N0M0, triple (-),
diagnosed in 2004.

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 Clinical course
2004 2005 2008

• left breast infiltrating ductal • Left lower lobe lung • LLL lobectomy
carcinoma, T2N0M0, triple (-) metastasis
• s/p partial mastectomy + • s/p LLL wedge resection
CCRT in 2004 & LND in 2005

2009 2010

• Brain & liver metastasis • craniotomy tumor resection

+ CCRT+ Gamma-knife
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Clinical course
• 8th Chemotherapy
2010/9/20
• Lipo-dox + Endoxan

• Fever to 38.3 °C
2010/9/28
• Neutropenia (WBC = 300)

2010/9/28 →Admission to ward

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9/28
CXR admission

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9/28 admission 10/1 10/11

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9/28 admission 10/1 10/11

Cavitary lesion with

intra-cavitary
consolidation mass
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 3cm- sized cavitary lesion in RUL
- Ball-in-hole lesion such as fungus infection

4mm wall

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Cavitary lung disease
• “A gas-filled space, seen as a lucency or low-attenuation area, within
pulmonary consolidation, a mass, or a nodule” , defined by the
Fleischner glossary

Parkar, A. P., & Kandiah, P. (2016). Differential Diagnosis of Cavitary

Lung Lesions. Journal of the Belgian Society of Radiology, 100(1),
100. 12
 Differential Diagnosis of cavitary lung
disease

Postgraduate Medical Journal, Volume 97, Issue 1150, August 2021, Pages 521–531 13
Malignancy
• Metastasis: SqCC (GI, breast), sarcoma, adenocarcinoma
• Spiculated margin
• Wall thickening ( > 24mm )
• Pleural retraction

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Pulmonary abscess
• a complication of pneumonia
• Air fluid level
• peripheral contrast enhancement and
necrotizing centre
• Pleural effusion/ empyema

air-fluid level (long arrow). Rim

enhancement (short arrows).
pleural effusion is also seen
(thick arrow).
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 Tuberculosis
• Reactivation tuberculosis (rarely in primary tuberculosis)
• parenchymal consolidation in apical and posterior segments of the upper lobes)
• Lower lung zone (immunocompromised)
• Satellite nodules (multiple perilesional nodules)
• Tree-in-bud nodules suggest active endobronchial spread. (not specific to TB)
• LAP, pleural effusion, wall thickening, ring enhancement, central necrosis (+/-)

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 Diseases Related to Aspergillus fumigatus

Panse P, et al., The many faces of pulmonary aspergillosis: Imaging findings with pathologic correlation, Radiology of
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Infectious Diseases (2016),
Aspergilloma
• Preexisting lung cavity + fungal ball (mycetoma)
• Monod sign
• The mobility of the cavity’s contents may be used to differentiate
it from other entities Chabi ML, Goracci A, Roche N, et al. Pulmonary aspergillosis. Diagn
Interv Imaging. 2015;96:435–442. doi: 10.1016/j.diii.2015.01.005.

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Invasive Aspergillosis
Angio-invasive
• Halo sign (nodular Airway-invasive
consolidation+ surrounding • airway thickening
GGO) • tree-in-bud
• Air crescent sign

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Monod sign vs. Air Crescent Sign
• When a crescent of air is seen
outlining the mycetoma against
the wall of the cavity, the
correct term is Monod sign.
• Monod signAspergilloma
The air crescent sign represents a crescent
of air from retraction of infarcted lung. It a
good prognostic sign as it indicates that the
patient is in the recovery phase.
Air crescent signrecovering angioinvasive
aspergillosis

Core Radiology-A Visual Approach to Diagnostic, 2013, P38-39 20

Semi invasive Aspergillosis
• Chronic necrotizing aspergillosis
• Centrally forming cavities +/- mycetoma
tree-in-bud

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 Back to patient
• CC: neutropenic fever
• Image findings:
• A 3cm cavitary lesion in RUL,
with central mass
ball-in-hole lesion such as fungus
infection
• Monod sign→ aspergilloma
• Tx:
• Voriconazole
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Thank you for your listening!

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