Seedling

A 40 year old man is referred by his primary care practitioner after his hemoglobin level is found to be 9 g/dl. He had originally presented with lightheadedness and fatigue.

Further questioning reveals a history of intermittent episodes of hemoptysis for the last 4 to 5 weeks.

His medical history is significant for successfully treated pulmonary tuberculosis 6 years ago. No other comorbidities are present, and he has never smoked.

Select Relevant Investigations
Chest X-Ray

Performed

A heterogeneous opacity is present in the left upper lobe.
Contrast CT Chest

Performed

The CT shows a cavitatory lesion in the left upper lobe, with a mass lesion inside.
Precipitin Antibodies

Performed

He tests positive for Aspergillus precipitins.
Bronchoscopy + Lavage

Performed

Bronchoscopy: no abnormalities
Cytology: no malignant cells noted
Microscopy: Silver staining reveals multiple hyphae which branch at acute angles, suggestive of aspergillosis.

Select Relevant Management
Antituberculous Therapy
Surgical Resection
IV Miconazole
Radiotherapy