PulmonaryAspergilloma Developing in a Giant Emphysematous Bulla

Pulmonary aspergilloma usually develops in a pre-existing pulmonary cavity and may present with hemoptysis. We report a 51-year-old former smoker with bilateral apical post-tuberculous sequelae, severe chronic obstructive pulmonary disease, chronic respiratory failure requiring long-term oxygen therapy, and a three-month history of worsening dyspnea, productive cough with intermittent mild hemoptysis (blood-streaked sputum), and right-sided pleuritic pain. Chest computed tomography demonstrated bilateral giant emphysematous bullae and a round intracavitary soft-tissue mass within a right upper-lobe cavity of uncertain origin, partially outlined by a crescent of air. Bronchoscopy showed marked traction-related bronchial distortion without an endobronchial lesion. Bronchial aspirate was positive for Aspergillus spp. by polymerase chain reaction and fungal culture, while investigations for active tuberculosis were negative. Surgical resection was considered unsuitable because of severely impaired pulmonary function and extensive parenchymal destruction. Itraconazole was initiated; during approximately eight months of therapy, two admissions for mild hemoptysis were followed by resolution, and the patient was otherwise reported to be clinically stable; no follow-up data were available after this period. This case illustrates an uncommon site of aspergilloma formation and emphasizes the diagnostic value of correlating characteristic imaging findings with microbiological results in patients with advanced structural lung disease.