Bronchial Aspergillosis Occurring as an Intracavitary “Fungus Ball”

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Abstract
This paper deals with the description of a 54-year-old white man who had a "fungus ball" in an ectatic bronchus. The lesion was clinically asymptomatic, but a rounded density with a radiolucent cap was noted in a roentgenogram of the chest that was made after the patient had undergone cholecystectomy for cholecystitis. The mass was removed in a segmental resection of the posterior basilar portion of the upper lobe of the left lung. Grossly, the mass was gray and putty-like. It lay within a cavity 4 cm in diameter, lined by a smooth membrane; the cavity connected directly with a bronchus, and it was lined with respira tory type of epithelium. The wall of the cavity was fibrous and contained plates of cartilage, as well as smooth muscle and large blood vessels with conspicuous subintimal fibrosis. The vascular changes are of some clinical significance, inasmuch as hemoptysis was the presenting symptom in 13 of the 18 patients previously described. Aspergillus sp. was isolated in cultures of the putty-like material from this patient''s bronchiectatic cavity, as well as in the 5 previously published instances in which fungi were identified in cultures.

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