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Chronic pulmonary aspergillosis — SCE Respiratory MCQ

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ModerateRespiratory InfectionsChronic pulmonary aspergillosisSCE Respiratory

A 71-year-old man with COPD and prior TB has chronic cough, weight loss and haemoptysis. CT shows a thick-walled upper-lobe cavity with a fungal ball and pleural thickening. Aspergillus IgG is strongly positive and symptoms have persisted for 4 months. What is the most likely diagnosis?

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Correct answer: B — Chronic pulmonary aspergillosis

Chronic cavitary disease with Aspergillus IgG positivity in a structurally abnormal lung is typical of chronic pulmonary aspergillosis. ABPA is an allergic airway disease with asthma and very high IgE rather than cavities. Invasive aspergillosis is usually acute in severe immunosuppression.

Reference: BTS Clinical Statement on Aspergillus-related Chronic Pulmonary Disease; ERS Aspergillosis guidance