Primary Pulmonary Aspergilloma Presenting as an Isolated Nodular Shadow

Abstract

A 55-year-old man was admitted to our hospital because of an abnormal shadow at the right hilum on a chest radiograph. The chest radiograph and the chest CT scan showed a nodular shadow in the right S⁶. There was no air-crescent sign in the shadow, but CT-guided percutaneous needle biopsy led to the diagnosis of pulmonary aspergillosis. Anti-fungal agents (miconazole, fluconazole, and itraconazole) were given but the patient's condition did not improve. Surgical resection was done and the postoperative course was uneventful. The resected lung had a bronchiectatic area with a fungus ball. Attempts to culture the fungus ball were not successful. Histologic examination revealed conidial heads characteristic of Aspergillus fumigatus. This case is interesting because the pulmonary aspergilloma appeared as an isolated nodular shadow. This might have been a case of primary pulmonary aspergilloma.