Abstract
The present study reports the case of a 67-year-old female patient who was initially diagnosed with pulmonary aspergilloma. This diagnosis was based on a chest computed tomography (CT) scan showing a cavitary lesion of 3.5 cm in diameter, with fungus ball-like shadows inside, and an air crescent sign in the right upper lung. At 63 years old, the patient was treated for transitional cell cancer of the urothelium (non-invasive, pT1N0M0) by total cystectomy, ileal conduit diversion and urostomy. For 4 years post-operatively, the patient was healthy and had no clinical symptoms, and the air crescent sign was not identified by chest CT until the patient had reached 67 years of age. However, a final diagnosis of lung metastasis of transitional cell cancer of the urothelium was histopathologically identified subsequent to video-assisted thoracic surgery. Although it is rare that transitional cell cancer moves to the lung and makes a cavitary lesion, a differential diagnosis of cancer is necessary, even when examining infected patients with air crescent signs that are characteristic of aspergilloma. The physician must be mindful of metastatic pulmonary tumors that closely resemble aspergillomas, not only in infectious diseases, but also in oncological practice. Primary surgical removal should be considered.
Highlights
Pulmonary aspergilloma is classified as non‐invasive pulmonary aspergillosis, and is a chronic debilitating disease withKey words: air crescent sign, fungus ball, aspergilloma, metastatic lung cancer, transitional cell cancer clinical symptoms that include a chronic cough, slight fever and bloody sputum
A fungus ball‐like structure is rarely found inside the lung cavity, in transitional cell cancer [5]
The present study reports a case of lung metastasis of transitional cell cancer of the urothelium in an asymptomatic patient who was initially diagnosed with pulmonary aspergilloma based on air crescent signs in the right upper lung
Summary
Pulmonary aspergilloma is classified as non‐invasive pulmonary aspergillosis, and is a chronic debilitating disease with. Subsequent to the finding of an abnormal shadow in the right upper lung, based on X‐rays taken during the follow‐up post‐operative testing in April 2012, the patient visited the Department of Respiratory and Infection Control (Tokai University Hachioji Hospital, Tokyo, Japan) for a detailed examination. No such shadow had been detected in the lung during testing the previous year. Based on the clinical and imaging findings, the patient was temporarily diagnosed with aspergilloma with a cavitary lesion and fungus ball‐like shadows in the right upper lung. Mycetes, including Aspergillus sp., were not detected in the isolated tissue
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