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Aspergilloma — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsAspergillomaSCE Infectious Diseases

A 55-year-old man with known bronchiectasis presents with haemoptysis and a mycetoma visible on CT chest — a mass within a pre-existing cavity with a surrounding air crescent. Aspergillus IgG is strongly positive. He has no systemic symptoms. What is the most appropriate management?

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Correct answer: B — Conservative management with monitoring; surgical resection if haemoptysis becomes life-threatening or recurrent

A simple aspergilloma (fungal ball within a pre-existing cavity) in an asymptomatic or mildly symptomatic patient is managed conservatively. Systemic antifungals have poor penetration into the cavity and limited efficacy against aspergilloma. Surgery (lobectomy) is reserved for significant or recurrent haemoptysis, and carries significant morbidity. Bronchial artery embolisation is useful for acute life-threatening haemoptysis as a temporising measure but is not definitive. Itraconazole may have a limited role in some cases but is not standard.

Reference: BTS 2017 – Aspergilloma/chronic pulmonary aspergillosis; NICE 2024 – Bronchiectasis