Abstract Introduction Aspergilloma or Fungus ball is a saprophytic infection caused by Aspergillus, a fungus usually in the preexisting cavitary lesions inpatients with tuberculosis, sarcoidosis, lung cancer, cystic fibrosis. CT findings include a soft-tissue mass with in a cavity surrounded by an air crescent, often referred to as ball-in-hole appearance. However, it can sometimes be inconclusive. Dynamic imaging with prone CT allows for direct visualization of mobility of the intracavitary mass, confirming a non-adherent fungal ball. Case A 67 year old female with H/O COPD, Sarcoidosis, Diabetes, Hypertension presented to our ED, sent from her PCPs office as she had hypoxia with SpO2of 70% on2l of oxygen through nasal cannula, which is her baseline. She was started on 6l of oxygen through nasal cannula and was admitted for the management of acute on chronic respiratory failure due to COPD exacerbation, and superimposed infection. CT Chest was done and showed 4.4cm thin-walled bulla in the superior segment of left lower lobe which contains an internal 14mm dependent nodule. Prone CT chest showed findings suggestive of an aspergilloma in the superior segment of the left lower lobe with a 4.6cm thin walled cavitation with a dependent nodule on prone positioning. As the patient was asymptomatic from the aspergilloma, it was decided not to treat her, but to monitor with sequential imaging. Discussion Aspergilloma typically presents with the “air crescent” or “monod” sign on imaging. Demonstration of mobility of the intracavitary mass with change in patient position from supine to prone confirms a nonadherent fungus ball and establishes the diagnosis confidently. Prone CT offers a simple, rapid, and non-invasive method to achieve this, eliminating the need for biopsy in typical cases. Biopsy carries a risk of bleeding and may not be warranted if imaging findings are characteristic. Contained, asymptomatic aspergillomas generally have a benign course and can be managed conservatively, reserving surgical intervention for recurrent hemoptysis or progressive disease. Prone CT is a valuable, non-invasive diagnostic tool for aspergilloma, confirming the diagnosis by demonstrating mobility of the fungus ball with in a preexisting cavity. Conclusion When findings are characteristic and the lesion is contained, biopsy is unnecessary, and treatment may not be required, provided the patient remains asymptomatic and underfollow-up. Utilization of prone CT in those settings can be invaluable. This abstract is funded by: None
Shaik et al. (Fri,) studied this question.