29th July 2023

Chronic pulmonary aspergillosis (and aspergilloma)

In which aspergillosis leads to fibrosis of the lungs, cavitation, and pleural thickening. Chronic pulmonary aspergillosis encompasses several diseases, such as aspergilloma, chronic cavitary pulmonary aspergillosis, chronic fibrosing pulmonary aspergillosis, and subacute invasive pulmonary aspergillosis. Aspergilloma is explored in greater detail below and is a frequent MRCP question.

Patients typically present with a chronic respiratory illness similar to bronchiectasis or COPD – chronic productive cough, wheeze, dyspnea – with intermittent episodic flare-ups marked by more acute symptoms and systemic upset. The condition may also be asymptomatic for long periods.

If asymptomatic, many cases can be managed with watchful-waiting, and vigilance for developing any complications. Steroids and antifungals may be used if a patient presents with acute symptoms. Chronic pulmonary aspergillosis is also associated with secondary bacterial chest infections, which are appropriately treated with antibiotics.

The condition can recur after treatment, so long-term monitoring and follow-up are essential.

Aspergilloma

An aspergilloma is a type of mycetoma – a ball of fungal material which forms a mass. They typically form in pre-existing lung cavities and are associated with a previous history of emphysema, tuberculosis and other cavitating lung diseases.

Most people with aspergillomas are asymptomatic, but they can cause a respiratory illness of wheezing, chronic cough, chest pain, haemoptysis and malaise. It is, therefore, an important differential diagnosis for this collection of symptoms.

Diagnosis is through chest x-ray, which will demonstrate the aspergilloma. The serum testing mentioned previously can be used to screen for Aspergillus. A definitive diagnosis can be made with a biopsy and fungal culture to confirm the aetiology.

Management is of chronic pulmonary aspergillosis, as outlined above.