Mediastinal aspergilloma: an unusual presentation as superior vena cava obstruction

Abstract

Pulmonary aspergilloma is the most common form of aspergillus infection in patients with pre-existing cystic or cavitary lung disease. Extrapulmonary aspergilloma, specifically, in the mediastinum, is an unusual pathologic manifestation of this organism. Aspergilloma presenting as superior vena cava (SVC) obstruction has rarely been seen. Here, we report a case of mediastinal aspergilloma in a 30-year-old female patient presented with signs and symptoms of SVC obstruction. The patient had a history of cough with expectoration along with progressive dyspnea on exertion for 3 months. A computerized tomographic chest showed a soft tissue density mass involving the mediastinum and compressing the SVC. Computed tomography-guided fine-needle aspiration cytology and trucut biopsy were performed, and the samples were examined histopathologically and subjected to culture, which yielded the growth of Aspergillus fumigatus. The patient responded well with itraconazole, with serial imaging showing a near complete resolution of the mass.