A Case of Pulmonary Aspergillosis (with many teaching points)
A man in his 50s presented to our clinic for evaluation. He is a former smoker. Symptoms started 4 years prior with cough and hemoptysis. He was found to have hilar lymphadenopathy with perihilar and upper lobe opacities. He was given the diagnosis of sarcoidosis. After developing recurrent hemoptysis, imaging was repeated and showed what looked like an aspergilloma. Indeed, transbronchial biopsy demonstrated epithelioid granulomas and cultures grew Aspergillus fumigatus . When first seen by us, he endorsed fatigue, poor exercise capacity and chronic productive cough. He had hemoptysis almost on a daily basis ranging from blood-tinged sputum to clots. He denied fevers. We reviewed the imaging findings. Prominent mediastinal and bilateral hilar lymphadenopathy was noted. Conglomerate opacities with volume loss and architectural distortion was also seen. Cavitary/cystic lesions were filled by nodular soft tissue admixed with gas. Below...