A 65-year-old man with a history of treated pulmonary tuberculosis presents with recurrent hemoptysis. Chest CT shows a thick-walled cavity in the left upper lobe containing a rounded, mobile mass that changes position with patient repositioning. What is the most likely diagnosis?

• A Cavitating squamous cell carcinoma
• B Rasmussen aneurysm
• C Lung abscess
• D Aspergilloma ✓

Explanation

Aspergilloma (fungal ball) characteristically appears as a mobile, rounded mass within a pre-existing cavity that changes position with patient movement, most commonly in old tuberculous cavities. Cavitating squamous cell carcinoma may have thick irregular walls but does not show a mobile intracavitary mass. A lung abscess contains an air-fluid level. A Rasmussen aneurysm is a pseudoaneurysm from pulmonary artery erosion, not a mobile mass.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.