Background. A rare case of necrotizing aspergilloma in the right lung emphysematic cavity.

Materials and methods. We are presenting a rare clinical case of fungal pathology: Aspergillus localized in lung bullae associated with emphysema. That is why clinical and X-ray appearance differs from classical aspergilloma.

Results. The patient underwent investigations due to the progression of tuberculosis, but it was not found. On chest X-ray the right upper lobe lung cancer was suspected. Haemoptysis was consistent, and the patient underwent right thoracotomy and lung resection (segmentectomy). Histology after the operation was chronic necrotizing aspergilloma. This case is unique and interesting, because necrotizing aspergilloma was localized in emphysematic cavity. Postoperative care was without complications, the patient returned to work in 3 months. In our case, depending on the process stage, lung resections (wedge or segmentectomies) were performed. Patient’s performance status and lung functions are of great importance.

Conclusions. 1. Surgery for chronic necrotizing pulmonary aspergillosis is mandatory in cases of: appearance of clinical manifestation of the disease, disease progression – bleeding from lungs, tumour size enlargement during conservative treatment. Surgery is prohibited when fungal disease is widely spread in both lungs. 2. The main surgical operation in case of necrotizing pulmonary aspergillosis is lung resection.

Keywords: chronic necrotizing pulmonary aspergillosis, aspergilloma of the lung, tuberculosis of the lung, haemoptysis, thoracic surgery