A Simplified Imaging and Serological Approach for Diagnosing Pulmonary Aspergilloma in Surgical Cases

BACKGROUND: Simple pulmonary aspergilloma (SPA) in chronic pulmonary aspergillosis (CPA) is characterized by a ball-like lesion within a pre-existing lung cavity. The detection rate of Aspergillus in cultures is low. There are no established clinical diagnostic methods specifically focused on SPA indicated for surgery. This study aimed to develop a simple and reliable diagnostic approach by integrating imaging and serological findings. METHODS: A retrospective study was conducted on 15 patients with ball-like lesions in lung cavities who underwent lung resection. Four imaging characteristics of CPA (cavity wall thickening, infiltrative shadow around the cavity, air crescent sign, and Monod sign) and three serological markers (elevated β-D-glucan, positive Aspergillus antibody, and positive Aspergillus antigens) were evaluated for their sensitivity and specificity. Positive likelihood ratio (PLR) was calculated. Two high-PLR factors-one from imaging and one from serology-were combined to construct a simplified diagnostic approach. RESULTS: Of the 15 patients, 7 were diagnosed with aspergilloma, 3 with lung cancer and 5 with other diseases. The two factors with the highest PLR were Aspergillus IgG antibody and cavity wall thickening. The combination was analyzed with Fisher's exact test with a sensitivity of 71.4%, specificity of 87.5% and a p-value of 0.041. CONCLUSION: This study demonstrated that combining Aspergillus IgG antibody and cavity wall thickening provides a simple and reliable approach to distinguish aspergilloma from other cavitary lung lesions.