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Clinical manifestations and diagnosis of chronic pulmonary aspergillosis

Author
David W Denning, MBBS, FRCP, FRCPath, FMedSci
Section Editor
Carol A Kauffman, MD
Deputy Editor
Anna R Thorner, MD

INTRODUCTION

Chronic pulmonary aspergillosis includes several disease manifestations, including aspergilloma, Aspergillus nodules, chronic cavitary pulmonary aspergillosis, and chronic fibrosing pulmonary aspergillosis. Subacute invasive pulmonary aspergillosis (formerly known as chronic necrotizing aspergillosis) is on the spectrum between chronic and acute forms of pulmonary aspergillosis (see 'Definitions' below). A duration of disease longer than three months distinguishes chronic pulmonary aspergillosis from acute and subacute pulmonary aspergillosis.

The pathophysiology, clinical manifestations, and diagnosis of chronic pulmonary aspergillosis will be reviewed here. The treatment of chronic pulmonary aspergillosis as well as allergic bronchopulmonary aspergillosis and invasive aspergillosis is discussed separately. (See "Treatment of chronic pulmonary aspergillosis" and "Clinical manifestations and diagnosis of allergic bronchopulmonary aspergillosis" and "Epidemiology and clinical manifestations of invasive aspergillosis".)

DEFINITIONS

Chronic pulmonary aspergillosis describes several patterns of disease. However, the terminology that has been developed can be difficult to apply to a spectrum of disease entities that have considerable overlap and variation in severity. The following terminology will be used to describe the spectrum of disease; each entity is characterized by specific radiographic findings [1,2].

Aspergilloma — An aspergilloma is a fungus ball composed of Aspergillus hyphae, fibrin, mucus, and cellular debris found within a pulmonary cavity [3]. Aspergillomas arise in preexisting pulmonary cavities that have become colonized with Aspergillus spp [1].

If the aspergilloma is single, the cavity stable over months, and the patient has few symptoms (ie, a mild cough only) and little evidence of systemic inflammation, a simple aspergilloma may be diagnosed. We will use the term "simple aspergilloma" to distinguish this entity from the more complex forms of chronic pulmonary aspergillosis. (See 'Diagnosis' below.)

                        

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Literature review current through: Nov 2016. | This topic last updated: Thu Sep 08 00:00:00 GMT+00:00 2016.
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