Aspergilloma in combination with adenocarcinoma of the lung

ulmonary aspergillosis occurs in parenchymal cavities or ectatic airways. Aspergillus is a ubiquitous dimorphic fungus. It rarely affects healthy people with an intact immune response, but those with preexisting structural lung disease, atopy, occupational exposure or impaired immunity are susceptible. 1 Aspergillosis can remain asymptomatic or present with hemoptysis, which can be life-threatening. In this report, we describe a patient who presented with an aspergilloma arising in a cavitating adenocarcinoma of the right lung. Case presentation A 54-year-old man, a smoker who was otherwise healthy, presented with history of cough productive of brownish sputum for 4 weeks. There was no history of chest pain, shortness of breath, fever or chills, and he denied any history of hemoptysis or weight loss. On physical examination, he appeared healthy with normal findings on chest, cardiovascular, abdominal and neurologic examinations. Chest radiography revealed a mass in the right upper lung zone, and on CT, there was a cavitary lesion in the posterior segment of the right upper lung lobe, with a central homogeneous rounded density typical of an aspergilloma (Fig. 1). His antifungal serum antibodies were nonreactive. Preoperative pulmonary function tests gave normal results. The patient underwent flexible bronchoscopy followed by right posterolateral thoracotomy. No abnormalities were found on bronchoscopic examination. On thoracotomy, a soft mass was palpable in the posterior segment of the right upper lobe, compati