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Pulmonary aspergilloma (mycetoma)


Alternative names

Fungus ball; Mycetoma; Aspergilloma

Definition

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

Causes, incidence, and risk factors

Aspergillomas are formed when the fungus Aspergillus grows in a clump in a pre-existing pulmonary (lung) cavity or when the organism 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. Pre-existing cavities in the lung may have been caused by a previous infection, such as histoplasmosis , tuberculosis , lung abscess , or by cystic fibrosis , sarcoidosis , or previous lung cancer . See also aspergillosis .

Symptoms

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

Signs and tests

  • Chest X-ray
  • Chest CT
  • Sputum culture
  • Bronchoscopy or bronchoscopy with lavage (BAL)
  • Serum precipitans for aspergillus (blood test to detect antibodies to aspergillus)

Treatment

The most effective therapy is surgical removal of the growth. If life-threatening bleeding occurs, emergency surgery may be the only option.

In some cases, angiography (injection of dye into the blood vessels) may be used to locate the site of bleeding, which can allow the physician to stop it. Occasionally, antifungal medications such as itraconazole and amphotericin B can be used. Sometimes these antifungals are added if complete surgical removal is not possible, or if the Aspergillus infection has expanded beyond the aspergilloma.

Expectations (prognosis)

The outcome can be good, if complete surgical removal of the abnormal lung is feasible.

Complications

  • Progressive difficulty breathing
  • Massive bleeding from the lung
  • Spread of the infection (see acute invasive aspergillosis )

Calling your health care provider

See your health care provider if coughing up blood occurs, 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.

Update Date: 11/16/2002

David A. Kaufman, M.D., Pulmonary & Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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Last updated: Tue, 06 Jan 2009 00:20:03 GMT
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