Elsevier

Lung Cancer

Volume 26, Issue 3, December 1999, Pages 195-198
Lung Cancer

Case report
Cavitary lung cancer with an aspergilloma-like shadow

https://doi.org/10.1016/S0169-5002(99)00080-XGet rights and content

Abstract

A 66-year-old man who complained of cough and haemoptysis had a cavitary lesion with the meniscus sign in the right lower lung field on his chest X-ray and CT scan. He had smoked 40 cigarettes daily, for about 46 years. Initially, he was diagnosed with aspergilloma and given an antifungal agent. After 2 months, the cavitary lesion showed a slight irregularity of the inner border. The walls were irregularly thickened and were surrounded by infiltrative densities compared with the previous chest radiograph. Enlargement of right hilar and mediastinal lymph nodes was also observed. The fungus ball-like shadow was fixed on the anterior wall of the cavity and its position was not altered with the patient’s movements. These radiographic findings led to suspicion that the lesion might be malignant. Transbronchial lung biopsy of the cavity wall and CT guided needle aspiration biopsy of the fungus ball-like lesion were performed. Microscopic examination revealed a squamous-cell carcinoma in both the cavity wall and the fungus ball-like lesion. There was no evidence of fungal elements. In conclusion, the meniscus sign is most often associated with benign diseases such as aspergilloma, however, one should remember that carcinoma may be a cause.

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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