A case of productive aspergilloma on the inner wall of a cavity, in which perbronchial fiberoptic bronchoscopy within the cavity was useful for the diagnosis and therapeutic evaluation

Abstract

A 45-year-old man complaining of bloody sputum was admitted. He had been treated for pulmonary tuberculosis since October 1988. He had bloody sputum in October 1989. His chest X-ray findings showed a cavitary lesion with a thickened and irregular wall in the right upper lobe. Fiberoptic bronchoscopy revealed white nodules on the cavity wall and the biopsy specimen from the nodule yielded a fungus granuloma. Aspergillus fumigatus was cultured from the sputum obtained after the bronchoscopy. Based on these findings, endobronchial aspergillosis and productive aspergilloma on the inner wall of a cavity was diagnosed. He was treated with oral anti-fungal drugs for 4 years. On chest X-ray films taken in June 1993, the cavity had enlarged, and the thickening and irregularity of the cavity wall had disappeared. Transbronchial fiberoptic bronchoscopy within the cavity showed whitish nodules and the cytology specimen obtained from the nodules by brushing yielded fungi, he was treated with oral itraconazol. Six months later, re-examination of the cavity revealed that the wall had become thinner and that the nodules on the inner wall had disappeared. This case illustrates the importance of bronchoscopy, in the diagnosis and evaluation of treatment of productive aspergilloma on the inner wall of a cavity.