114 Clinical presentation is similar to that for any chronic sinusitis. 110 The maxillary sinus is the most common site for a sinus aspergilloma to occur. 113Īspergillus can also be associated with fungus balls of the sinuses without tissue invasion. Dense adhesions make pleural drainage difficult, often requiring pleural stripping, further compromising lung function. Contamination of the pleural space with Aspergillus and the common complication of bronchopleural fistula in the postoperative period can lead to chronic Aspergillus empyema. 113 Surgical resection is considered the definitive therapy, but the dense pleural adhesions adjacent to the fungus ball and the poor pulmonary reserve of most patients make surgery hazardous. In many patients the fungus ball due to Aspergillus remains asymptomatic, but in a significant number of patients hemoptysis occurs and can be fatal. The detection of Aspergillus in sputum cultures or detection of high titers of Aspergillus antibodies are further evidence that the radiographic findings are consistent with a diagnosis of fungus ball due to Aspergillus so that a biopsy is not usually necessary except to diagnose the underlying lung disease. 112 On chest radiograph a pulmonary aspergilloma appears as a solid round mass in a cavity. Typically, Aspergillus fungus balls of the lung develop in preexisting cavities in the pulmonary apex of patients with chronic lung disease, such as bullous emphysema, sarcoidosis, tuberculosis, histoplasmosis, congenital cyst, bacterial lung abscess, or, very rarely, in a pulmonary bleb from Pneumocystis pneumonia in patients with AIDS. Bennett MD, in Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 2020 Fungus Balls Due to AspergillusĪ pulmonary fungus ball due to Aspergillus, or aspergilloma, is a solid mass of hyphae growing in a previously existing pulmonary cavity.
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