Note the large vascular channels with little smooth muscle in their walls. These branches of the bronchial artery can be a source of bleeding. The cavity may be lined by epithelium that often includes foci of squamous metaplasia. An air crescent lies above the fungus ball, which may move when the patient changes position. Cavitating abscess or neoplasm, and a hematoma in a cavity are included in the radiographic differential diagnosis.
Therapeutic options are controversial.
In a retrospective study of 85 patients, there was no difference in 5-year survival of patients with little or no hemoptysis treated medically or by surgical resection. Ryan P, Stableforth D, Reynolds J, Muhdi K. Treatment of pulmonary aspergilloma in cystic fibrosis by percutaneous instillation of amphotericin B via indwelling catheter. Glimp R, Bayer A. Pulmonary aspergilloma. Diagnostic and therapeutic considerations. Analysis of 23 cases.