Generally they tend to be solitary but may be multiple or bilateral. The natural history of pulmonary aspergillomas is not well documented. They generally persist indefinitely as saprophytic infections. Rarely does invasive disease develop. Pulmonary aspergilloma has been successfully treated with a wide variety of fungicidal agents including Amphotericin B, oral clotrimazole, and by aerosolized Amphotericin B or Nystatin.
Surgical resection is obviously curative.
Extrinsic allergic alveolitis is a form of hypersensitivity reaction that occurs in susceptible individuals after repeated and heavy inhalation of certain organic antigens including spores of aspergillus. Within the alveolar septa and bronchioles the spores produce an acute cellular inflammatory response composed of small lymphocytes and plasma cells. There is associated cellular and interstitial edema and occasionally areas of necrosis. The response is believed to be due to complex interactions between inflammatory responses produced by cell mediated reactions and compliment activation by immune complexes. The classic x- ray feature of allergic alveolitis is a diffuse micronodular pulmonary infiltrate.