A 38-year-old non-smoker woman presents with haemoptysis. CT chest shows a cavitary lesion in right upper lobe with an intracavitary mass that a crescent of air above it. Serum Aspergillus galactomannan is elevated. She is immunocompetent with no recent illness. What is this condition called and what is the BEST treatment?
- A Aspergilloma (simple); itraconazole or surgical resection for haemoptysis ✓
- B Invasive pulmonary aspergillosis; IV voriconazole
- C Allergic bronchopulmonary aspergillosis; prednisolone
- D Chronic pulmonary aspergillosis; long-term voriconazole
Explanation
The air-crescent sign (Monod sign) — a mass within a pre-existing cavity with a crescent of air — is pathognomonic of aspergilloma (mycetoma). It represents Aspergillus fungal ball growing in a pre-existing lung cavity (post-TB, sarcoidosis, bullae). In immunocompetent patients with simple aspergilloma and significant haemoptysis, surgical resection is the definitive treatment; antifungal therapy (itraconazole) is used for non-surgical candidates. Invasive aspergillosis causes progressive consolidation/nodules in immunocompromised patients. ABPA presents with bronchiectasis, mucus plugging, and elevated IgE.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.