The Evolution of Pulmonary Tuberculosis to Pulmonary Aspergiloma in PortHarcourt: A Need for Radiologic Pulmonary Vigilance

Mycetoma or fungus ball is a clump of mould which exists in the human body cavity caused by fungi of the genus Aspergillius. Simple aspergillomas are often asymptomatic however it can clinically present with Cough, haemoptysis and wheezing. The study was aimed at documenting the evolution of pulmonary tuberculosis (PTB) to pulmonary aspergiloma in patients with long-standing pulmonary tuberculosis. Chest radiographs and computed tomographic (CT) scans were evaluated to demonstrate the evolution of pulmonary tuberculosis to aspergiloma. The initial chest radiograph showed inhomogeneous opacities in the left upper lung zone with backgrounds nodular and streaky changes. Subsequent chest radiographs demonstrated thick walled cavitary lesion with an oval shaped mass within it having a surrounding crescentic halo. A plan radiologic diagnosis of pulmonary tuberculosis with subsequent development of pulmonary aspergiloma was made. Follow up contrast enhanced axial section chest CT scan showed a fairly well-defined non-enhancing iso-hyperdense lesion with a surrounding halo giving the air crescent sign at the left upper lung zone. Aspergiloma can be seen on both plain radiographs and computed tomograms. Mr A.D., a 49 year old male who presented with a history of cough of three weeks duration. The cough is productive of sputum and haemoptysis. He has taken anti-PTB drugs 4 times but is still presenting with cough due to pulmonary aspergiloma secondary to previous pulmonary tuberculosis, thus a need for radiologic pulmonary vigilance.