Aspergilloma — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRespiratoryAspergillomaRACP Adult Medicine

A 60-year-old man with a history of TB 20 years ago presents with massive haemoptysis (600 mL in 24 hours). CXR shows a rounded opacity within a pre-existing upper lobe cavity with a crescent of air around it (Monod sign). What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Aspergilloma (mycetoma)

A fungal ball within a pre-existing lung cavity with the characteristic air crescent (Monod sign) on CXR/CT is pathognomonic for an aspergilloma. It is a saprophytic colonisation by Aspergillus, not an invasive infection. Massive haemoptysis is the most dangerous complication, caused by erosion into bronchial arteries. Acute management of haemoptysis includes positioning (bleeding side down), bronchial artery embolisation, and possible surgical resection for recurrent life-threatening haemoptysis. Antifungals alone are generally ineffective.

Reference: eTG – 2025 – Respiratory; BTS – 2016 – Aspergillus Guidelines