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Imaging showed right upper lobe tuberculosis sequelae with consolidation, while bronchoscopy revealed a yellowish friable endobronchial mass with mild bleeding. Bronchoalveolar lavage identified Aspergillus fumigatus by culture, with strongly positive Aspergillus antigen and serum Aspergillus-specific IgG, supporting endobronchial aspergillosis. Itraconazole was started, and the patient underwent right upper lobectomy; histopathology confirmed a fungus ball with characteristic septate hyphae. No major hemoptysis recurred during follow-up.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/aspergilloma-presenting-as-endobronchial-mass/459947/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/aspergilloma-presenting-as-endobronchial-mass/459947.png","ImageObject",300,407,{"name":92,"@type":93},"Dipper","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What symptoms and risk factors led to suspicion of endobronchial aspergillosis?","Question",{"text":113,"@type":114},"The patient had hemoptysis that worsened over a week, with radiological evidence of tuberculosis sequelae. He had no diabetes, HIV, malignancy, or immunosuppressive treatment, and no smoking history.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How was endobronchial aspergillosis confirmed?",{"text":118,"@type":114},"Diagnosis was made by integrating clinical, bronchoscopic, laboratory, and radiological parameters. BAL culture grew Aspergillus fumigatus, BAL Aspergillus antigen was strongly positive, and histopathology after surgery confirmed a fungus ball with characteristic Y-shaped septate hyphae.",{"name":120,"@type":111,"acceptedAnswer":121},"What treatment strategy was used and what was the outcome?",{"text":122,"@type":114},"Itraconazole 400 mg daily was initiated based on local guidelines, with therapeutic drug monitoring performed. Surgery (right upper lobectomy) was performed to prevent recurrence, itraconazole was resumed for one month postoperatively, and no major hemoptysis recurred over six months of follow-up.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},459947,1790816172,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":39,"preview_page_count":4},1374404997633,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Images of Interest  \nAspergilloma Presenting as Endobronchial Mass  \nAli Chour1,2,3, David Laville3,4, Benjamin Chappuy3,5 and Nicolas Marc1  \n1Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, 2Oncopharmacology Lab, Lyon Cancer Research Center, UMR INSERM 1052, CNRS 5286, Lyon, 3Claude Bernard Lyon 1 University, Lyon, 4Thoracic Pathology Departement, 5Thoracic Surgery Departement, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France  \nA 40-year-old man with a history of pulmonary tuberculosis during childhood in Congo, presented to the emergency department for hemoptysis. He reported mild hemoptysis for years, which had significantly worsened over the past week. The patient had no significant past medical history other than childhood pulmonary tuberculosis. He was immunocompetent with no history of diabetes, human immunodeficiency virus infection, malignancy, or immunosuppressive treatment. He had no history of smoking.  \nBlood laboratory investigations were normal with no biological inflammatory syndrome (white blood cell count, 4.37 g/L; C-reactive protein, 3 mg/L) . Pulmonary computed tomography revealed tuberculosis sequelae in the right upper lobe with surrounding consolidation (Figure 1A) . Flexible bronchoscopy revealed obstruction of the apical segmental bronchus (B1) of the right upper lobe by a yellowish, friable soft-tissue mass with a granular aspect, increased vascularity, and mild active bleeding (Figure 1B) . Bronchoscopy biopsy was not performed to avoid worsening the observed bleeding. Instead, bronchoalveolar lavage (BAL) was undertaken, providing comprehensive diagnostic information: bacteriological analysis was negative, mycobacteriological analysis was negative, mycological culture revealed one colony formation unit of Aspergillus fumigatus, BAL Aspergillus antigen was strongly positive (enzyme-linked immunosorbent assay [ELISA] Platelia Aspergillus Bio-Rad [Hercules, CA, USA] on Evolis automate, threshold: 0.5), and direct examination showed an absence of suspicious cells but the presence of mycelial filaments on GrocottGomori’s methenamine silver staining. Serum Aspergillus-specific immunoglobulin G (IgG) antibodies were strongly positive at 55 AU/mL (ELISA anti-Aspergillus IgG Bio-Rad; normal \u003C10 AU/mL) .  \nThe diagnosis of endobronchial aspergillosis (EBA) was made by integrating the clinical, bronchoscopic, laboratory, and radiological parameters. Given that antifungal drug susceptibility testing was not available, itraconazole (400 mg daily) was initiated based on local guidelines. Therapeutic drug monitoring was performed; no dosage adjustment was required. The patient was referred from the time of diagnosis to the surgical team to avoid hemoptysis recurrence. Treatment was continued for 1 month until the surgery, without recurrence of major hemoptysis.  \nThe patient underwent a right upper lobectomy without any complication. Histopathological analysis confirmed an EBA, showing a dilated bronchial cavity containing fragmented fungal material (‘fungus ball’) (Figure 1C), highlighted by distinctive Y-shaped, branching septate hyphae with a high affinity for Grocott-Gomori’s methenamine silver staining (Figure 1D) . No vascular involvement was found. Antifungal therapy by itraconazole was resumed after the surgery for 1 month. To date, after 6 months of clinical follow-up, hemoptysis has not recurred.  \nEBA is a rare form of chronic pulmonary aspergillosis characterized by the endo-  \n[https://doi.org/10.4046/trd.2025.01](https://doi.org/10.4046/trd.2025.01)17  \nISSN: 1738-3536(Print)/ 2005-6184(Online)  \nTuberc Respir Dis 2026;89:117-119  \nCopyright © 2026 The Korean Academy of Tuberculosis and Respiratory Diseases  \nAddress for correspondence Ali Chour  \nRespiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France  \nE-mail [ali.chour@chu-lyon.fr](ali.chour@chu-lyon.fr)[ ](ali.chour@chu-lyon.fr)[Received](Received Jul. 14)[ Jul. 14](Received","cbCaidZLG2P4Qqej","https://ap.wps.com/l/cbCaidZLG2P4Qqej","pdf",10593823,"English","# Clinical presentation and history\n# Diagnostic workup\n## Laboratory and bronchoscopic findings\n## Imaging\n# Management and outcome","[{\"question\":\"What symptoms and risk factors led to suspicion of endobronchial aspergillosis?\",\"answer\":\"The patient had hemoptysis that worsened over a week, with radiological evidence of tuberculosis sequelae. He had no diabetes, HIV, malignancy, or immunosuppressive treatment, and no smoking history.\"},{\"question\":\"How was endobronchial aspergillosis confirmed?\",\"answer\":\"Diagnosis was made by integrating clinical, bronchoscopic, laboratory, and radiological parameters. BAL culture grew Aspergillus fumigatus, BAL Aspergillus antigen was strongly positive, and histopathology after surgery confirmed a fungus ball with characteristic Y-shaped septate hyphae.\"},{\"question\":\"What treatment strategy was used and what was the outcome?\",\"answer\":\"Itraconazole 400 mg daily was initiated based on local guidelines, with therapeutic drug monitoring performed. Surgery (right upper lobectomy) was performed to prevent recurrence, itraconazole was resumed for one month postoperatively, and no major hemoptysis recurred over six months of follow-up.\"}]","Aspergilloma Presenting as Endobronchial Mass | PDF",1790757321]