Aspergilloma, otherwise known as a fungus ball, is a ball made up of fungal masses, mucus, and cellular debris in body cavities such as the lungs. It occurs when airborne fungus Aspergillus readily available in the environment colonizes an already existing cavity in the lung, made, perhaps, by tuberculosis, sarcoidosis, or some chronic lung diseases. Given that TB has a high prevalence in India, aspergilloma becomes a very important consideration in patients with a history of pulmonary tuberculosis
Causes and Risk Factors
Aspergillomas usually form when Aspergillus spores enter the lung and settle in cavities left by previous infection or structural damage; such cavities offer a favorable environment for the fungus to grow.
Common risk factors include:
● History of pulmonary tuberculosis
● Chronic obstructive pulmonary disease (COPD)
● Sarcoidosis
● Lung abscesses or bronchiectasis
● Immunocompromised states, such as HIV/AIDS or chemotherapy
Patients may present with or without symptoms, depending on the severity of symptoms, which vary according to the size and location of the aspergilloma.
Common symptoms include:
Hemoptysis (coughing up blood) – a hallmark symptom, sometimes life-threatening
● Chest pain
● Breathlessness
● Fatigue
● Fever, in rare or complicated cases
Massive hemoptysis may occasionally develop, which is a life-threatening situation requiring emergency treatment.
How is Aspergilloma Diagnosed?
Timely diagnosis is paramount to avoid complications. In TB-related lung damage cases in India, both the patient and the doctor require awareness.
Diagnostic methods include:
1. Chest X-ray or CT scan
○ Shows a characteristic “fungus ball” often moving within a lung cavity.
2. Sputum Culture and Microscopy
○ Helps identify Aspergillus species.
3. Serologic Tests (Aspergillus IgG antibody)
○ Confirms exposure to Aspergillus.
4. Bronchoscopy
○ May be used in select cases to visualize the airways or obtain samples.
Serologic Tests (Aspergillus IgG antibody)
Confirms exposure to Aspergillus.
Bronchoscopy
It may be used in select cases to visualize the airways or obtain samples.
Treatment Options in India
Treatment of aspergilloma depends on how symptomatic the patient is, as well as on his overall health.
1. Observation
Asymptomatic patients may simply be observed. There is no need for treatment unless symptoms appear.
2. Antifungal Medications
Antifungals such as itraconazole and voriconazole can reduce the fungal burden. However, they are rarely used as monotherapy against fungal balls.
3. Surgical Resection
Surgical treatment is the most definitive, especially in patients with recurrent or life-threatening hemoptysis. Lobectomy (removal of the affected lobe of the lung) is the most commonly performed procedure.
Note: Surgery has its risks and must be performed by an experienced thoracic surgeon.
4. Bronchial Artery Embolization (BAE)
In emergency cases of massive hemorrhages, BAE can be employed as a minimal intervention for the temporary control of hemoptysis or in preparation for operative treatment.
Living with Aspergilloma: Follow-Up & Care
The patients should be regularly monitored for the recurrence of symptoms. Long-term management includes:
● Routine imaging
● Monitoring hemoptysis
● Managing underlying lung conditions
● Avoiding dust exposure and mold-prone environments
Why Early Detection Matters in India
Due to the heightened TB burden and environmental exposure to fungal spores in India, the incidence of aspergilloma is not rare. Late diagnosis can result in heavy bleeding and many complications. Hence, it is essential for awareness, especially for those formerly treated with TB.
Conclusion
Aspergilloma or fungus ball is quite a grave condition, but with timely diagnosis and adequate treatment, it can be effectively managed. Consult a pulmonologist or thoracic surgeon immediately if you or anyone with you with a history of tuberculosis and chronic lung disease has been coughing up blood.
At drkamranali.com, we strive to provide expert evaluation and advanced surgical care for all conditions concerning the lung, including aspergilloma.
Book your consultation today and begin the journey to better lung health.
