The mycetoma is a mass which is the mixture of fungal hyphae, granulation tissue,
and necrotic tissue debris within previous pulmonary cavity. Among the mycetomata,
aspergilloma is the most frequent one and the most clearly defined pulmonary form of
aspergilloisis because of its characteristic roentgenographic finding. The underlying cause
was tuberculosis, sarcoidosis, bronchiectasis, emphysematous bullae, bronchial cyst,
pulmanary infarction, lung abscess, hematologic malignancies, and prolonged
corticosteroid or antibiotics therapy. Among these causes, tuberculosis is the most
frequent one. The chest X-ray provide the best clue in the suspected patient, and the
diagnosis of aspergilloma was done when serologic test is positive. The major clinical
problem is pulmonary hemorrhage.
The most effective therapy is surgical excision, but confined to the patient who has
unilateral disease with single obvious aspergilloma, experienced a second bout of severe
pulmonary hemorrhage, and no major impairment of pulmonary function.
A 50 year-old male patient was admitted due to chest discomfort and dizziness for 1
year and a generalized seizures. He have had very irregular antituberculous medications
for 20 years due to cough, hemoptysis, hypertensions for 15 years, and right hemiparesis
two times transiently (8 years and 4 years ago). The clinical sign and laboratory result
were not unusual. Roentgenogram of his chest showed multiple nodular calcifications in
the right upper lung field, and chest CT revealed fibrostreaky shadows and multiple thin
walled bullae on the right lung field with an homogenous mass about 2.5 ㎝ in diameter
And the brain CT scan showed isodensity tumor moss in the left parietal convexity
with contrast enhancement. Sputum examination for tubercle bacilli and malignant cell
were negative, but sputum smear and culture for aspergilli were positive, and serologic
test was positive for Aspergillus fumigatus. Transbronchial lung biopsy revealed
aspergilli and craniotomy for brain tumor showed meningiomatous meningioma.
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