Pulmonary mycetoma.

A computed tomography (CT) scan in supine position of 25-year-old male with the complaint of recurrent haemoptysis showed a solid round mass within a cavity partially surrounded by a radiolucent crescent (crescent sign) in apical segment of right lower lobe [Figure 1]. CT scan in the prone position shows that the mass moved within the cavity with the change in position [Figure 2]. The patient had history of pulmonary tuberculosis in the past for which he had taken adequate course of antitubercular treatment. At present she had no history of fever, anorexia, and weight loss. Sputum for acid fast bacilli was negative. Routine hematological and biochemical investigations were normal.

Figure 1

CT thorax showing round mass within a cavity partially surrounded by a radiolucent crescent (crescent sign) in apical segment of right lower lobe

Figure 2

CT scan in the prone position shows that the mass moved within the cavity with the change in position

Q1. What is your diagnosis?

ANSWER

Pulmonary aspergilloma complicating healed pulmonary tuberculosis.

DISCUSSION

Pulmonary aspergilloma is a saprophytic form of aspergillosis which results from in growth of fungus aspergillus in damaged bronchopulmonary tissues caused by various lung diseases, most commonly, tubercular cavity.[1] Radiologically it presents as a ball-like lesion inside a cavity, partially surrounded by a radiolucent sign (Monod's sign).[2] CT is more reliable than chest radiograph in defining a fungus ball.[34]