Pulmonary aspergilloma in 20 patients: contribution of computed tomography

OBJECTIVE: Aspergilloma is the most common form of pulmonary aspergillosis. The purpose of this work was to compare computed tomographic findings with features observed on standard radiographs. PATIENTS AND METHODS: We retrospectively reviewed 20 cases of pulmonary asp ergilloma. These patients (mean age 36 years) were followed after cure of p ulmonary tuberculosis and consulted for hemoptysis. All underwent computed tomography (CT) and standard radiographic explorations. Serology was positi ve for Aspergillus in 16 cases and clinical and radiographic findings led t o the diagnosis in the 4 others. Both supine and prone positions were used for thoracic CT. Slice thickness was 5 mm without contrast injection. RESULTS: In many cases, standard films evidenced the typical mycetoma seen as a rounded mass of soft tissue density filling a portion of a preexisting cavity or as an air crescent sign, but atypical alveolar opacities, aeric images without aspergillosis colonization and parenchymal destruction predo minated in certain cases. The CT-scan demonstrated these features even bett er revealing the typical cavity in 80% of the cases or an air crescent in 2 0%. Mobility of the fungus ball was demonstrated by comparison of the prone and supine images. The characteristic CT features allowed certain diagnosi s of aspergilloma in 6 patients with atypical radiographic or serologic res ults. DISCUSSION: Computed tomography is highly contributive to the diagnosis of pulmonary aspergillosis, particularly in case of small cavities that may be missed on the standard films. Recognition of the mobility of the fungal ba ll enables differentiation from a tumor or infectious lesion. CT is also he lpful for guiding transparietal treatment. CONCLUSION: A computed tomography series should be obtained in former tuber culosis patients consulting for hemoptisis.