Pulmonary aspergilloma. Diagnostic and therapeutic considerations.

Pulmonary aspergillomas usually arise from colonization and proliferation of Aspergillus in preexisting parenchymal cavities. The most common symptom in this disorder is hemoptysis, which may be massive and life-threatening. Although positive sputum cultures for Aspergillus are present in more than half of patients with aspergilloma, this is neither a sensitive nor specific diagnostic marker. Virtually all patients with this syndrome have serum precipitating antibodies to Aspergillus antigens, and this serves as a useful confirmatory test in patients with suspected aspergilloma. The routine chest roentgenograph and standard tomography remain the most important diagnostic procedures. The computed tomograph of the chest may be helpful in certain cases. Routine surgical resection of aspergillomas is not recommended but should be reserved for patients with recurrent, severe hemoptysis who can tolerate thoracotomy. Parenteral antifungal therapy has not been effective in this disease; however, selected patients may be candidates for intracavitary antifungal therapy.