The CXR shows a right upper lobe ball within a cavity (air crescent sign) patho-gmonic of a mycetoma (also called aspergilloma). A lateral decubitus X-ray may demonstrate the fungal ball shifting position. In this condition, a preformed cavity becomes colonized, usually by the fungus Aspergillus fumigatus. Cavitary disease may be secondary to fibrotic lung disease, e.g. previous tuberculosis, sarcoidosis, or ankylosing spondylitis. Massive hemoptysis can result and bronchial angiogram with embolotherapy (using coils or gel foam) is temporizing. Surgical resection is definitive, but bronchopleural fistula may result. Unfortunately, most patients have insufficient pulmonary reserve to allow surgical resection.
Case 18. This 68-year-old female had recurrent epistaxis. This was her CXR (Fig. 18.1). What is the diagnosis?
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