They occur in about 15% of patients after thoracic surgery [2] or develop spontaneously due to an underlying pulmonary disease such as bullous emphysema, advanced interstitial lung disease, lung cancer, or cavernous tuberculosis.
Pulmonary aspergilloma is usually located in the upper lobes and it develops in the pre-existing cavities which has a direct communication to a bronchiole, usually sequels of tuberculosis, bullous emphysema, cysts, or cancer.[sup][3],[4] The radiological signs include air crescent sign and finger-in-glove appearance and movement of the fungus ball within the cavity when comparing upright and decubitus, which strongly suggested the diagnosis of pulmonary aspergilloma.[sup][5] The “ball-in-hole” aspect was found in our patients, but, if observed closely, we can discover that the shape of the ball in the cavity was different between the supine and prone positions.
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