Case reportCavitary lung cancer with an aspergilloma-like shadow
Introduction
The pulmonary meniscus sign, a rounded mass in the lung capped by a crescent-shaped collection of air, has been typically applied to aspergilloma [1], [2]. This meniscus sign, also known as the air cap, double arch, or air crescent sign, was originally thought to be pathognomonic of the echinococcal lung cyst. It has been reported that the meniscus sign can also be seen in other benign conditions [3]. In contrast, there are few reports which have described lung cancer with the meniscus sign and to our knowledge, chest CT finding of the meniscus sign associated with lung cancer has not yet been reported. Recently, we experienced a patient who initially appeared to have an aspergilloma, however, a biopsy revealed lung cancer.
Section snippets
Case report
A 66-year-old man was referred to our hospital because of a 2-month history of cough and blood-stained sputum. He had smoked 40 cigarettes daily for about 46 years. It was found, 2 months before admission to our hospital, that his chest X-ray and CT scan of the chest showed a cavitary lesion with the meniscus sign in the right lower lung field (Fig. 1). Therefore, he was diagnosed with aspergilloma and given an antifungal agent (fluconazole) by a general practitioner.
In our hospital, he
Discussion
The air meniscus sign above a rounded pulmonary mass has been described in a number of conditions. This includes hydatid disease [4], lung abscess with pus and blood clots [5] and tuberculous cavitation with Rasmussen’s aneurysm formation [6]. Aspergillosis is usually considered to be an opportunistic infection. The fungus ball, which is now considered to be characteristic of aspergilloma, was first reported by Devé in 1939 [1], [7], [8]. The diagnostic criteria for aspergilloma have included a
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Cited by (27)
Fluorodeoxyglucose-PET/computed tomography-guided biopsy
2016, PET ClinicsCitation Excerpt :It is preferable to access the lesion through a nonaerated route to avoid the risk of pneumothorax. When the lesion is cavitary or has air bronchogram, the biopsy is obtained from the wall of the lesion or the most solid part of the lesion.29 If a major vessel or a bone is along the way of a planned trajectory for the biopsy, various maneuvers can be helpful, such as changing the position of the patient's leg or arm, taking a more medial or lateral path (Fig. 5), rotating the patient, puncturing the patient from the opposite side if feasible, and changing the respiration.
Cavitary lung cancer with an aspergilloma-like shadow
2010, Journal of Thoracic OncologyAdenocarcinoma of the lung presenting as a mycetoma with an air crescent sign
2007, ChestCitation Excerpt :In addition, in patients with a pulmonary mycetoma (fungal ball), the radiographic feature is usually evident as an upper lobe cavitary lesion with an intracavitary mobile mass and an air-crescent sign on the periphery.56 A change in the position of the mycetoma occurring when the patient changes his position is a valuable radiologic sign for the diagnosis of mycetoma.57 Thus, the classic CT scan workup of a mycetoma would include both supine and prone scanning studies to demonstrate whether the central mass is free or attached to the cystic wall.
Pulmonary cavitary mass containing a mural nodule: differential diagnosis between intracavitary aspergilloma and cavitating lung cancer on contrast-enhanced computed tomography
2007, Clinical RadiologyCitation Excerpt :In such a case, the differential diagnosis between intracavitary aspergilloma (fungus ball) and cavitating lung cancer is important for the determination of the patient's outcome and treatment planning. On reviewing the literature, only one case report was found that investigated the differences between the two lesions.1 Therefore, the purpose of this study was to retrospectively identify any significant differences between the CT findings of each condition to aid the differential diagnosis.
The clinical spectrum of pulmonary aspergillosis
2002, ChestCitation Excerpt :The differential diagnosis of this radiologic appearance includes hematoma, neoplasm, abscess, hydatid cyst, and Wegener granulomatosis. It is important to note that aspergilloma may coexist with any of the above conditions.24,25 A sputum examination may reveal the presence of Aspergillus but is negative in 50% of the cases.26
Lingular segmentectomy and left lower lobectomy via unique bronchial dissection
2018, Journal of Thoracic Disease