Chronic Pulmonary Aspergillosis Masquerading as a Tumor-like Mass with a Stone-paved Appearance

Abstract

Chronic pulmonary aspergillosis (CPA) typically presents with imaging findings such as cavities, fungal balls, and thickened cavity walls, with chronic cavitary pulmonary aspergillosis being the most common form. Diagnosing CPA can be challenging when imaging findings appear as a mass. We report a woman in her 70s referred to our hospital for a gradually enlarging abnormal lung shadow. Her medical history included pulmonary tuberculosis at the age of 50 years. Chest computed tomography (CT) revealed a progressively enlarging mass without a cavity, featuring partial calcification and apparent continuity with nodular opacities in the left lower lobe. Contrast-enhanced CT revealed a tumor-like mass with contrast-enhancing septations, having a stone-paved appearance. Bronchoscopy indicated stenosis of the trachea and left main bronchus. A CT-guided lung biopsy was performed, and Aspergillus terreus was identified in the culture of the biopsied specimen, leading to a CPA diagnosis. Voriconazole was administered, causing mass size reduction, as evidenced by follow-up imaging. This report highlights that CPA should be considered in patients with a tumor-like mass with a stone-paved appearance, even without residual cavitation from pulmonary tuberculosis.