Endobronchial aspergilloma – Presenting as solitary pulmonary nodule

Abstract

As compared to aspergilloma which is usually developed after complication of tuberculosis in India, endobronchial aspergilloma is a rare disease entity. We report a rare case of endobronchial aspergilloma which is presented radiologically as a solitary pulmonary nodule. A 24-year-old male presented to the Department of Tuberculosis and Chest Diseases with moderate to severe hemoptysis for the last three months. Chest X-ray (PA view) showed ill-defined homogenous shadow in the right upper zone. CECT Thorax review showed intrabronchial mass in the posterior segment of the right upper lobe. CT-guided FNAC was performed, which reveals Aspergillus hyphae mixed with sputum and necrotic material, without any evidence of malignancy. Fibreoptic bronchoscopy was done, it reveals a ball-like region, occluding partially, the lumen of the posterior segment of right upper lobe with hyperemia. The ball was movable. Biopsy was performed and it revealed a partially eroded lining of metaplastic squamous epithelium, overline of chronically inflamed granulation tissue and scar intermingled with fungal hyphae. Serological test for Aspergillus precipitin was positive. The ball was removed using forceps and basket. Endobronchial aspergilloma may be present as solitary pulmonary nodule on chest X-ray. Bronchoscopic and endobronchial biopsies are invaluable in the diagnosis of endobronchial aspergilloma.