Radiology Quiz

Pulmonary mycetoma
Sanjay Singhal
Department of Medicine, Command Hospital, Kolkata, India

Address for correspondence: Dr. Sanjay Singhal, Chest Specialist, Command Hospital, Kolkata-700027, India. E mail: drsanjaysinghal79@yahoo.co.in

A computed tomography (CT) scan in supine position
of 25-year-old male with the complaint of recurrent
haemoptysis showed a solid round mass within a cavity
partially surrounded by a radiolucent crescent (crescent sign)
in apical segment of right lower lobe [Figure 1]. CT scan in
the prone position shows that the mass moved within the
cavity with the change in position [Figure 2]. The patient
had history of pulmonary tuberculosis in the past for which
he had taken adequate course of antitubercular treatment.
At present she had no history of fever, anorexia, and weight
loss. Sputum for acid fast bacilli was negative. Routine
hematological and biochemical investigations were normal.
Q1. What is your diagnosis?

Figure 1: CT thorax showing round mass within a cavity partially Figure 2: CT scan in the prone position shows that the mass moved
surrounded by a radiolucent crescent (crescent sign) in apical segment within the cavity with the change in position
of right lower lobe

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DOI:
10.4103/0970-2113.92374

Lung India • Vol 29 • Issue 1 • Jan - Mar 2012 81

 Singhal: Pulmonary mycetoma
ANSWER
Pulmonary aspergilloma complicating healed pulmonary
tuberculosis.
DISCUSSION
Pulmonary aspergilloma is a saprophytic form of
aspergillosis which results from in growth of fungus
aspergillus in damaged bronchopulmonary tissues caused
by various lung diseases, most commonly, tubercular
cavity.[1] Radiologically it presents as a ball-like lesion
inside a cavity, partially surrounded by a radiolucent sign
(Monod’s sign).[2] CT is more reliable than chest radiograph
in defining a fungus ball.[3,4]
82 Lung India • Vol 29 • Issue 1 • Jan - Mar 2012
REFERENCES
1. Gupta PR, Vyas A, Meena RC, Sharma S, Khayam N, Subramanian
IM, et al. Clinical profile of pulmonary aspergilloma complicating
residual tubercular cavitations in Northen Indian patients. Lung India
2010;27:209-11.
2. Goldberg B. Radiologic appearances in pulmonary aspergillosis. Clin
Radiol 1962;13:106.
3. Roberts CM, Citron KM, Stnckland BS. Intrathoracic aspergilloma: Role
of CT diagnosis and treatment. Radiology 1987;165:123.
4. Breuer R, Baigelman W, Pugthegn RD. Occult mycetoma. J Comput
Assist Tomogr 1982;6:166.
How to cite this article: Singhal S. Pulmonary mycetoma. Lung
India 2012;29:81-2.
Source of Support: Nil, Conflict of Interest: None declared.