A Case of Aspergilloma That Developed in Cystic Bronchiectasis with Right Upper Lobe Resection

Abstract

Background. It is rare to encounter bronchiectasis dominant in the upper lobe of the right lung in Japan, and while aspergilloma may occur in cases of bronchiectasis, it is relatively rare. Case. A 66-year-old woman suddenly developed about 50 ml of hemoptysis at rest, and she was transported to our hospital by ambulance. Computed tomography (CT) revealed a mass lesion with distinct borders in the right upper lobe as well as numerous cystic lesions in the right upper lobe. A mass in the upper lobe of the right lung had been observed about three years earlier at another hospital, but it had not been examined because the patient did not want to undergo a further examination at that time. Enhanced CT showed no abnormal blood vessels that might have been causing the bleeding. We examined her with bronchoscopy and confirmed bleeding from the right upper lobe. Bronchial lavage was performed, but both a cytodiagnosis and a culture test were negative. Positron emission tomography (PET)/CT showed no accumulation in the mass and no increase in β-D glucan. Although her bloody sputum stopped, the possibility hemoptysis redeveloping and potential malignancy remained; therefore, right upper lobectomy was performed. A pathological examination showed the growth of filamentous fungi, identified as Aspergillus, inside the cyst on bronchial or bronchiolar dilation. Conclusion. We experienced a case of aspergilloma that developed in cystic bronchiectasis with hemoptysis that was resected and it was also associated with rare imaging findings.