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A ball or mass made of Aspergillus fungi that can form in the lungs of patients with suppressed immune systems
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How is an aspergilloma diagnosed?
A fungal mass (aspergilloma) in the lung usually does not produce clear symptoms and is generally diagnosed when seen on chest x rays
Pulmonary aspergilloma (mycetoma)?
DefinitionPulmonary aspergilloma is a mass caused by a fungal infection that usually grows in lung cavities. It can also appear in the brain, kidney, or other organs.Alternative NamesFungus ball; Mycetoma; AspergillomaCauses, incidence, and risk factorsAspergillomas are formed when the fungus aspergillusgrows in a clump in a lung cavity, or invades previously healthy tissue, causing an abscess.Aspergillus is a common fungus. It grows on dead leaves, stored grain, bird droppings, compost piles, and other decaying vegetation. Cavities in the lung may have been caused by:CoccidiomycosisCystic fibrosisHistoplasmosisLung abscessLung cancerSarcoidosisTuberculosisSee also: AspergillosisSymptomsMany patients have no symptoms. When symptoms do develop, they can include:Chest painCoughCoughing up blood (seen in up to 75% of patients)FeverMalaiseUnintentional weight lossShortness of breathWheezingSigns and testsBlood test for presence of aspergillus in the body (galactomannan)Blood test to detect antibodies to aspergillus (serum precipitins for aspergillus)Bronchoscopy or bronchoscopy with lavage (BAL)Chest CTChest x-raySputum cultureTreatmentOften, no treatment is needed, unless you are coughing up blood.In some cases, injecting dye into the blood vessels (angiography) may be used to find the site of bleeding. The bleeding can then be stopped by shooting tiny pellets into the bleeding vessel. Surgery is another option to control bleeding, and is often the only choice if there is life-threatening bleeding.Occasionally, antifungal medications may be used.Expectations (prognosis)The outcome can be good in many patients. However, it depends on the severity of the condition and other factors.In some people, surgery can be very effective when it is successful, but this surgery is complex and can have a high risk of serious complications.Many patients never develop symptoms and do not need any form of treatment.ComplicationsDifficulty breathing that gets worseMassive bleeding from the lungSpread of the infection (see acute invasive aspergillosis)Calling your health care providerSee your health care provider if you cough up blood, and mention any other symptoms that have developed.PreventionPeople who have had related lung infections or who have weakened immune systems should try to avoid environments where the aspergillus fungus is found.ReferencesPatterson TF. Aspergillus species. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005: chap 256.
Pulmonary aspergilloma?
DefinitionPulmonary aspergilloma is a mass caused by a fungal infection that usually grows in lung cavities. It can also appear in the brain, kidney, or other organs.Alternative NamesFungus ball; Mycetoma; AspergillomaCauses, incidence, and risk factorsAspergillomas are formed when the fungus aspergillusgrows in a clump in a lung cavity, or invades previously healthy tissue, causing an abscess.Aspergillus is a common fungus. It grows on dead leaves, stored grain, bird droppings, compost piles, and other decaying vegetation. Cavities in the lung may have been caused by:CoccidioidomycosisCystic fibrosisHistoplasmosisLung abscessLung cancerSarcoidosisTuberculosisSee also: AspergillosisSymptomsMany patients have no symptoms. When symptoms do develop, they can include:Chest painCoughCoughing up bloodFatigueFeverUnintentional weight lossSigns and testsBlood test for presence of aspergillus in the body (galactomannan)Blood test to detect antibodies to aspergillus (serum precipitins for aspergillus)Bronchoscopy or bronchoscopy with lavageChest CTChest x-raySputum cultureTreatmentMany patients never develop symptoms. Often, no treatment is needed, unless you are coughing up blood.Occasionally, antifungal medications may be used.Sometimes, injecting dye into the blood vessels (angiography) may be used to find the site of bleeding. The bleeding is stopped by shooting tiny pellets into the bleeding vessel.Surgery is often the only choice if there is life-threatening bleeding.Expectations (prognosis)The outcome can be good in many patients. However, it depends on the severity of the condition and your overall health.Surgery may be very successful in some cases, but it is complex and can have a high risk of serious complications.ComplicationsDifficulty breathing that gets worseMassive bleeding from the lungSpread of the infection (see acute invasive aspergillosis)Calling your health care providerSee your health care provider if you cough up blood, and mention any other symptoms that have developed.PreventionPeople who have had related lung infections or who have weakened immune systems should try to avoid environments where the aspergillus fungus is found.ReferencesPatterson TF. Aspergillus species. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005: chap 256.Reviewed ByReview Date: 09/15/2010David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Aspergillosis?
DefinitionAspergillosis is an infection, growth, or allergic response due to the Aspergillus fungus.Causes, incidence, and risk factorsAspergillosis is caused by a fungus (Aspergillus), which is commonly found growing on dead leaves, stored grain, compost piles, or in other decaying vegetation. It can also be found on marijuana.Although most people are frequently exposed to aspergillus, infections caused by the fungus rarely occur in people with a normal immune system. The rare infections caused by aspergillus include pneumonia and fungus ball (aspergilloma).There are several forms of aspergillosis:Pulmonary aspergillosis - allergic bronchopulmonary type -- is an allergic reaction to the fungus that usually develops in people who already have lung problems (such as asthma or cystic fibrosis).Aspergilloma -- is a growth (fungus ball) that develops in an area of previous lung disease or lung scarring (such as tuberculosis or lung abscess).Pulmonary aspergillosis - invasive type -- is a serious infection with pneumonia that can spread to other parts of the body. This infection occurs almost exclusively in people with weakened immune systems due to cancer, AIDS, leukemia, organ transplantation, chemotherapy, or other conditions or medications that lower the number of normal white blood cells or weaken the immune system.SymptomsSymptoms depend on the type of infection. For symptoms of aspergillosis-related growth, see aspergilloma.Symptoms of allergic bronchopulmonary aspergillosis may include:CoughCoughing up blood or brownish mucous plugsFeverGeneralized ill feeling (malaise)WheezingWeight lossRecurrent episodes of lung airway obstructionAdditional symptoms seen in invasive aspergillosis depend on the part of the body affected, and may include:Bone painBlood in the urineChest painChillsDecreased urine outputEndocarditisHeadachesIncreased sputum production, which may be bloodyMeningitisShortness of breathSinusitisSkin sores (lesions)Vision problemsSigns and testsTests to diagnose Aspergillus infection include:Aspergillosisantibody testChest x-rayComplete blood countCT scanGalactomannan (a molecule derived from the fungus, which is sometimes found in the blood)Sputum stain and culture for AspergillusTissue biopsy(see bronchoscopy with transtracheal biopsy)TreatmentA fungus ball is usually not treated (with antifungal medicines) unless there is bleeding into the lung tissue. In that case, surgery is required.Invasive aspergillosis is treated with several weeks of an antifungal drug called voriconizole. It can be given orally or in an IV (directly into a vein). Amphotericin B, eichinocandins, or itraconazole can also be used.Endocarditis caused by Aspergillus is treated by surgically removing the infected heart valves. Long-term amphotericin B therapy is also needed.Antifungal drugs do not help people with allergic aspergillosis. Allergic aspergillosis is treated with immunosuppressive drugs -- most often prednisone taken by mouth.Expectations (prognosis)People with allergic aspergillosis usually get better gradually, with treatment. It is common for the disease to come back (relapse) and need repeat treatment.If invasive aspergillosis does not get better with drug treatment, it eventually leads to death. What happens to a person with invasive aspergillosis also depends on the underlying disease and immune system function.ComplicationsAmphotericin B can cause kidney impairment and unpleasant side effects such as fever and chillsBronchiectasis (permanent scarring of the small sacs in the lungs)Invasive lung disease can cause massive bleeding from the lungMucous plugsPermanent airway obstructionRespiratory failureCalling your health care providerCall your health care provider if you develop symptoms of aspergillosis or if you have a weakened immune system and develop a fever.PreventionBe careful when using medications that suppress the immune system. Prevention of AIDS prevents certain diseases, including aspergillosis, that are associated with a damaged or weaken immune system.ReferencesStevens DA. Aspergillosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 360.Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical pratice guidelines of the Infections Diseases Society of America. Clin Infect Dis. 2008;46(3):327-60.
Chest x-ray?
A chest x-ray is a diagnostic imaging test that uses a small amount of radiation to create images of the structures within the chest, including the heart, lungs, ribs, and diaphragm. It is commonly used to detect conditions such as pneumonia, lung cancer, heart failure, and rib fractures.
Sarcoidosis?
DefinitionSarcoidosis is a disease in which swelling (inflammation) occurs in the lymph nodes, lungs, liver, eyes, skin, or other tissues.Causes, incidence, and risk factorsThe cause of the disease is unknown. In sarcoidosis, clumps of abnnormal tissue (granulomas) form in certain organs of the body. Granulomas are clusters of immune cells.The disease can affect almost any organ of the body, but it most commonly affects the lungs.Possible causes of sarcoidosis include:Excess sensitivity to environmental factorsGeneticsExtreme immune response to infectionThe condition is more common in African Americans than Caucasians. Females are usually affected more often than males. The disease typically begins between the ages of 20 and 40. Sarcoidosis is very rare in young children.SymptomsThere may be no symptoms. When symptoms occur, they can involve almost any part or organ system in your body.Almost all patients have lung or chest symptoms:Dry coughShortness of breathDiscomfort behind your breast boneAbnormal breath sounds (such as rales)Symptoms of general discomfort or uneasiness often occur:Ill feeling (malaise)Fatigue (one of the most common symptoms in children)FeverWeight loss(one of the most common symptoms in children)Joint achiness or pain (arthralgia)Skin symptoms:Skin rashesOld scars become more raisedRaised, red, firm skin sores (erythema nodosum), almost always on the front part of the lower legsSkin lesionsHair lossNervous system (neurological) and vision changes:HeadacheSeizuresWeakness or paralysis (palsy) on one side of the faceEye burning, itching, and dischargeSymptoms of uveitisDecreased tearingOther symptoms of this disease:Enlarged lymph glands (armpit lump)Enlarged liverEnlarged spleenDry mouthNosebleedSigns and testsOften the disease is found in patients with no symptoms who have an abnormal chest x-ray.Different imaging tests may help diagnose sarcoidosis:Chest x-ray to see if the lungs are involved or lymph nodes are enlargedCT scanLung gallium (Ga.) scanBiopsies of different tissues may be done:Lymph node biopsySkin lesion biopsyBronchoscopy to perform a biopsyOpen lung biopsyMediastinoscopy with biopsyLiver biopsyKidney biopsyNerve biopsyHeart biopsyThis disease may also alter the results of the following lab tests:CBCChem-7 or chem-20Quantitative immunoglobulins (nephelometry)PTHSerum phosphorusImmunoelectrophoresis - serumCalcium - urineCalcium - ionizedCalcium - serumLiver function testsTreatmentSarcoidosis symptoms often get better on their own gradually without treatment.Severely affected patients may need treatment with corticosteroids (prednisone or methylprednisolone). This includes people who have involvement of the eyes, heart, nervous system, and some with lung involvement. Therapy may continue for 1 or 2 years. Some of the most severely affected patients may require life-long therapy.Drugs that suppress the immune system (immunosuppressive medicines), such as methotrexate, azathioprine, and cyclophosphamide, are sometimes used in addition to corticosteroids. Rarely, some people with irreversible organ failure require an organ transplant.Although these treatments may temporarily improve the symptoms of the disease, long-term treatment has not been proven to prevent sarcoidosis from slowly getting worse.Expectations (prognosis)Many people are not seriously ill, and the disease may get better without treatment. About 30 - 50% of cases get better without treatment in 3 years. About 20% of those whose lungs are involved will develop lung damage.The overall death rate from sarcoidosis is less than 5%. Causes of death include:Scarring of lung tissue (pulmonary fibrosis)Bleeding from the lung tissueInvolvement of the heart (rarely)ComplicationsOsteoporosisand other complications of taking corticosteroids for longer periods of time.Diffuse interstitial pulmonary fibrosisPulmonary hypertensionFungal lung infections (aspergilloma)Anterior uveitisGlaucoma and blindness (rare)Cardiac arrhythmiasCranial or peripheral nerve palsiesHigh calcium levels (hypercalcemia)Kidney stonesOrgan failure, leading to the need for a transplantCalling your health care providerCall your health care provider if you have:Difficulty breathingVision changesPalpitationsOther symptoms of this disorderReferencesWeinberger SE. Sarcoidosis. Goldman L, Ausiello D. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa:Saunders Elsevier; 2007:chap 95.Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357:2153-2165.
Routine sputum culture?
DefinitionRoutine sputum culture is a test of secretions from the lungs and bronchi (tubes that carry air to the lung) to look for bacteria that cause infection.Alternative NamesSputum cultureHow the test is performedYou will cough deeply and spit any sputum into a sterile cup. The sputum is then taken to the laboratory. There, it is placed in a special substance (medium) under conditions that allow the bacteria or fungi to grow.How to prepare for the testDrinking a lot of water and other fluids the night before the test may help to get the sample.How the test will feelYou will need to cough. Sometimes the health care provider will tap on the chest to loosen deep sputum. There may be a steam-like mist to inhale to help you cough up the sample.Why the test is performedThe culture is done on the sputum to help identify the bacteria that are causing an infection in the lungs or airways (bronchi).Normal ValuesIn a normal sputum sample there will be no disease-causing organisms present.What abnormal results meanIf the sputum sample is abnormal, the results are called "positive." Identifying disease-producing organisms may help diagnose:BronchitisLung abscessPneumoniaTuberculosisOther conditions under which the test may be performed:Aspiration pneumoniaAtypical mycobacterial infectionAtypical pneumoniaBlastomycosisBronchiectasisCoccidioidomycosis; acute (primary) pulmonaryCoccidioidomycosis; chronic pulmonaryCoccidioidomycosis; disseminatedCryptococcosisDisseminated tuberculosis (infectious)Histoplasmosis; acute (primary) pulmonaryHistoplasmosis; chronic pulmonaryHospital-acquired pneumoniaMycoplasma pneumoniaPlaguePulmonary aspergilloma (mycetoma)Pulmonary aspergillosis; invasive typePulmonary tuberculosisViral pneumoniaWhat the risks areThere are no risks with this method of obtaining a sample.Special considerationsSometimes a Gram stain or AFB stain of the sputum done at the same time can help make the diagnosis.
Bronchoscopy?
DefinitionBronchoscopy is a test to view the airways and diagnose lung disease. It may also be used during the treatment of some lung conditions.Alternative NamesFiberoptic bronchoscopyHow the test is performedA bronchoscope is a device used to see the inside of the lungs. It can be flexible or rigid. Usually, a flexible bronchoscope is used. The flexible bronchoscope is a tube less than 1/2 inch wide and about 2 feet long.The scope is passed through your mouth or nose, through your windpipe (trachea), and then into your lungs. Going through the nose is a good way to look at the upper airways. The mouth method allows the doctor to use a larger bronchoscope.A rigid bronchoscope requires general anesthesia. You will be asleep.If a flexible bronchoscope is used, you will be awake. The doctor will spray a numbing drug (anesthetic) in your mouth and throat. This will cause coughing at first, which will stop as the anesthetic begins to work. When the area feels thick, it is numb enough. You may get medications through a vein (intravenously) to help you relax.If the bronchoscopy is done through the nose, numbing jelly will be placed into one nostril.Once you are numb, the tube will be inserted into the lungs. The doctor may send saline solution through the tube. This washes the lungs and allows the doctor to collect samples of lung cells, fluids, and other materials inside the air sacs. This part of the procedure is called a lavage.Sometimes, tiny brushes, needles, or forceps may be passed through the bronchoscope and used to take tissue samples (biopsies) from your lungs. The pieces of lung material that are removed are small. The doctor can also place a stent in the airway or view the lungs with ultrasound during a bronchoscopy.How to prepare for the testDo not eat or drink anything 6 - 12 hours before the test. Your doctor may also want you to avoid any aspirin, ibuprofen, or other blood-thinning drugs before the procedure.You may be sleepy after the test, so you should arrange for transportation to and from the hospital.Many people want to rest the following day, so make arrangements for work, child care, or other obligations. Usually, the test is done as an outpatient procedure, and you will go home the same day. Some patients may need to stay overnight in the hospital.How the test will feelLocal anesthesia is used to relax the throat muscles. Until the anesthetic begins to work, you may feel fluid running down the back of your throat and have the need to cough or gag.Once the anesthetic takes effect, you may have sensations of pressure or mild tugging as the tube moves through the windpipe (trachea). Although many patients feel like they might suffocate when the tube is in the throat, there is NO risk of suffocation. If you cough during the test, you will get more anesthetic.When the anesthetic wears off, your throat may be scratchy for several days. After the test, the cough reflex will return in 1 - 2 hours. You will not be allowed to eat or drink until your cough reflex returns.Why the test is performedYou may have a bronchoscopy to help your doctor diagnose lung problems. Your doctor will be able to inspect the airways or take a biopsy sample.Common reasons to perform a bronchoscopy are:Lung growth, lymph node, atelectasis, or other changes seen on an x-ray or other imaging testSuspected interstitial lung diseaseCoughing up blood (hemoptysis)Possible foreign object in the airwayCough that has lasted more than 3 months without any other explanationInfections in the lungs and bronchiInhaled toxic gas or chemicalYou may also have a bronchoscopy to treat a lung or airway problem, such as:Remove fluid or mucus plugs from your airwaysRemove a foreign object from your airwaysWiden (dilate) an airway that is blocked or narrowedDrain an abscessTreat cancer using a number of different techniquesWash out an airway (therapeutic lavage)Normal ValuesNormal cells and secretions are found. No foreign substances or blockages are seen.Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.What abnormal results meanGranulomasInfections from bacteria, viruses, fungi, parasites, or tuberculosis Aspiration pneumoniaCMV pneumoniaChronic pulmonary coccidioidomycosisCryptococcosisChronic pulmonary histoplasmosisPneumonia with lung abscessPulmonary actinomycosisPulmonary aspergilloma (mycetoma)Pulmonary aspergillosis (invasive type)Pulmonary histiocytosis X (eosinophilic granuloma)Pulmonary nocardiosisPulmonary tuberculosisInflammation of the lungs related to allergy-type reactions (hypersensitivity pneumonitis)Interstitial lung diseaseLung cancer or cancer in the area between the lungsNarrowing (stenosis) of the trachea or bronchiRheumatoid lung diseaseSarcoidosisVasculitisWhat the risks areThe main risks from bronchoscopy are:Bleeding from biopsy sitesInfectionThere is also a small risk of:ArrhythmiasBreathing difficultiesFeverHeart attackLow blood oxygenPneumothoraxSore throatIn the rare instances when general anesthesia is used, there is some risk for:Muscle painChange in blood pressureSlower heart rateNauseaVomitingThere is a small risk for:Heart attackWhen a biopsy is taken, there is a risk of severe bleeding (hemorrhage). Some bleeding is common. The technician or nurse will monitor the amount of bleeding.There is a significant risk of choking if anything (including water) is swallowed before the numbing medicine wears off.Special considerationsAfter the procedure, your gag reflex will return. However, until it does, do not eat or drink anything.To test if the gag reflex has returned, place a spoon on the back of your tongue for a few seconds with light pressure. If you don't gag, wait 15 minutes and try it again. Make sure that you don't use any small or sharp objects to test this reflex.ReferencesKraft M. Approach to the patient with respiratory disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 83.Reynolds HY. Respiratory structure and function: mechanisms and testing. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 85.Prakash UBS. Bronchoscopy. In: Mason RJ, Murray J, VC Broaddus, Nadel J, eds. Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 22.
