Endobronchial aspergilloma: report of 10 cases and literature review

Abstract

Purpose: A retrospective investigation of the clinical and radiologic features as well as the bronchoscopic appearance was carried out in patients with endobronchial aspergilloma.

Materials and methods: Ten patients with endobronchial aspergilloma diagnosed by bronchoscopy and histological examination were identified at the Gyeongsang University Hospital of Korea, from May 2003 to May 2009.

Results: The patients included 9 men and 1 woman, and the age of the patients ranged from 36 to 76 (median, 58 years). The associated diseases or conditions were: previous pulmonary tuberculosis in 7 patients, lung cancer in 2 patients, pulmonary resection in 1 patient, and foreign body of the bronchus in 1 patient. The chest radiologic finding showed fibrotic changes as a consequence of previous tuberculosis infection in 6 patients and a mass-like lesion in 2 patients. Two patients had a co-existing fungus ball, and an endobronchial lesion was suspected in only 2 patients on the CT scan. The bronchoscopic appearance was a whitish to yellow necrotic mass causing bronchial obstruction in 7 patients, foreign body with adjacent granulation tissue and whitish necrotic tissue in 1 patient, whitish necrotic tissue at an anastomosis site in 1 patient, and a protruding mass with whitish necrotic tissue in 1 patient.

Conclusion: An endobronchial aspergilloma is a rare presentation of pulmonary aspergilosis and is usually incidentally found in immunocompetent patients with underlying lung disease. It usually appears as a necrotic mass causing bronchial obstruction on bronchoscopy and can be confirmed by biopsy.

Fig. 1

Patient 1 (A) Chest radiograph of a 75-year-old man shows a large mass like shadow in the left upper lobe. (B) The CT scan shows a non-enhanced mass with a multi-lobulated contour in the left upper lobe. (C) The bronchoscopy shows a protruding whitish mass in the upper bronchus of the left upper lobe. (D) The histologic examination shows numerous hyphae with background necrotic debris (H&E, ×100). H&E, hematoxylin and eosin.

Fig. 2

Patient 2 (A) The CT scan shows a small high density lesion in the right bronchus intermedius (arrow). (B) The bronchoscopy shows a foreign body-like lesion covered with whitish necrotic material. Patient 3 (C) The bronchoscopy shows granulation tissue with whitish material at the stump site. (D) Histopathologic examination revealed abundant necrotic material with multiple mycelia consisting of septate hyphae branching at an angle of approximately 45°, characteristic of aspergillus species (H&E, ×100). H&E, hematoxylin and eosin.

Fig. 3

Patient 6 (A) Chest radiograph of a 46-year-old man shows multiple calcified nodule and fibrotic changes with volume loss in the both lung zones. (B) The CT scan shows a suspicious fungus ball in the left upper lobe. (C) The bronchoscopy shows a whitish mass lesion causing obstruction of the apical segment of the left upper lobe.