Intracavitary nodule in active tuberculosis: differential diagnosis of aspergilloma - Respiratory Research & Clinical Practice

TO THE EDITOR:

A 40-year-old male presented to the emergency room with a three-month history of cough, fever, and weight loss. Twenty-four hours later, he also presented sudden hemoptysis. A chest X-ray revealed bilateral non-homogeneous opacities, predominantly in the left lung. Chest CT showed small nodules scattered throughout both lungs, with cavities in the left lung. We also noted a nodule inside a cavity, with air interposed between the nodule and the cavity wall-the air crescent sign (ACS)-suggesting an intracavitary fungus ball. The nodule showed intense enhancement after contrast administration, suggesting a diagnosis of Rasmussen aneurysm (RA; ). Fiberoptic bronchoscopy showed active bleeding from the lower left lobar bronchus. Sputum and BAL fluid were positive for AFB, subsequently identified as Mycobacterium tuberculosis . Treatment with antituberculosis drugs was started, and vascular occlusion with coil embolization was performed successfully. The patient was discharged from the hospital one month later.

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