Abstract
A 73-year-old woman with previous history of chronic asthma presented to our clinic. A Chest radiograph showed a small nodular shadow in the right upper lung field. Chest computerized tomography (CT) scan showed a mass 40 mm in maximum diameter in the left lung S8 and a mass 13 mm in maximum diameter in the right lung S3. Positron emission tomography (PET)/CT showed high accumulation of 18F-fluorodeoxyglucose (FDG) in the lesion of the left lung while no accumulation of 18F-FDG in the lesion of the right lung. The tumor in the left lung had increased in size on chest CT scan taken two months later. Primary lung cancer was suspected and surgical treatment was planned. The tumor was suspected to be malignant intraoperatively using needle biopsy and we performed thoracoscopic left-lower-lobe resection. A fungal spawn was observed in a viscous liquid embolism. Pathological analysis indicated the presence of a large mass of acidophilic, necrotic material in the dilated bronchus. There was an epithelioid granuloma on the bronchus wall, and allergic bronchopulmonary aspergillosis (ABPA) was diagnosed. In ABPA, it is possible for 18F-FDG accumulation to be observed upon 18F-FDG-PET/CT analysis along with high CEA levels. Generally, differentiating between ABPA and malignant tumors is difficult. Therefore, patients with asthma who are diagnosed with a lung tumor using the aforementioned modalities merit additional testing to differentiate between ABPA and lung cancer.
