title: Aspergillus fumigatus fungus ball in the pleural cavity.
abstract: OBJECTIVE
  To report the cases of 6 patients with fungus ball caused by Aspergillus fumigatus (aspergilloma) in the pleural cavity.
  
  
  METHODS
  Between 1980 and 2009, 391 patients were diagnosed with aspergilloma at the Santa Casa Hospital Complex in Porto Alegre, Brazil. The diagnosis of aspergilloma in the pleural cavity was made through imaging tests revealing effusion and pleural thickening with air-fluid level; direct mycological examination revealing septate hyphae, consistent with Aspergillus sp.; and positive culture for A. fumigatus in the surgical specimen from the pleural cavity.
  
  
  RESULTS
  Of the 391 patients studied, 6 (2%) met the established diagnostic criteria. The mean age of those 6 patients was 48 years (range, 29-66 years), and 5 (83%) were male. The most common complaints were cough, expectoration, and hemoptysis. Four patients (67%) had a history of tuberculosis that had been clinically cured. All of the patients were submitted to surgical removal of the aspergilloma, followed by intrapleural instillation of amphotericin B, in 4; and 2 received systemic antifungal treatment p.o. There was clinical improvement in 5 patients, and 1 died after the surgery.
  
  
  CONCLUSIONS
  In adult patients with a history of cavitary lung disease or pleural fistula, a careful investigation should be carried out and fungal infection, especially aspergilloma, should be taken into consideration. In such cases, laboratory testing represents the most efficient use of the resources available to elucidate the diagnosis.
authors.affiliation: Laboratório de Micologia, Hospital Santa Rita, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil.
authors.forename: Luciana Silva
authors.initials: LS
authors.lastname: Guazzelli
authors.forename: Cecília Bittencourt
authors.initials: CB
authors.lastname: Severo
authors.forename: Leonardo Santos
authors.initials: LS
authors.lastname: Hoff
authors.forename: Geison Leonardo Fernandes
authors.initials: GL
authors.lastname: Pinto
authors.forename: José Jesus
authors.initials: JJ
authors.lastname: Camargo
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Severo
mesh_terms: D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000000981:diagnostic imaging* / Q000382:microbiology; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D035422:Pleural Cavity / Q000000981:diagnostic imaging / Q000382:microbiology*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors