Medical image of the week: valley fever cavity with fungus ball

• Main Author: Robbins RA
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2018-05-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: coccioidomycosis; valley fever; fungus ball; cavity; thin walled; aspergilloma; hemoptysis; treatment; CT scan; fluconazole
• Online Access: http://www.swjpcc.com/imaging/2018/5/16/medical-image-of-the-week-valley-fever-cavity-with-fungus-ba.html

No abstract available. Article truncated at 150 words. A 72-year-old man was seen in 2010 because of hemoptysis. In 2004 a routine chest x-ray discovered a new pulmonary nodule (Figure 1, Figure 2A). Coccioidomycosis by complement fixation and IgM were negative but IgG was elevated at 0.203 (upper limit of normal 0.150). A transthoracic needle biopsy revealed a granuloma without malignancy and no growth of any organisms. He was followed because he was asymptomatic. He remained asymptomatic but developed a thin-walled cavity (Figure 2B). However, beginning in 2008 he developed a cough with occasional hemoptysis. His thoracic CT scan was repeated and was interpreted as showing findings consistent with a fungus ball (Figure 2C). He was treated with fluconazole for about 6 months but his hemoptysis persisted and therapy was switched to itraconazole. His hemoptysis persisted although it was somewhat improved. A repeat CT scan performed in 2010 (Figure 2D) continued to show the fungus ball. He was …