title: Aspergillus nodules; another presentation of Chronic Pulmonary Aspergillosis.
abstract: There are a number of different manifestations of pulmonary aspergillosis. This study aims to review the radiology, presentation, and histological features of lung nodules caused by Aspergillus spp.
  
  
  
  Patients were identified from a cohort attending our specialist Chronic Pulmonary Aspergillosis clinic. Patients with cavitating lung lesions, with or without fibrosis and those with aspergillomas or a diagnosis of invasive aspergillosis were excluded. Demographic, laboratory, and clinical data and radiologic findings were recorded.
  
  
  
  Thirty-three patients with pulmonary nodules and diagnostic features of aspergillosis (histology and/or laboratory findings) were identified. Eighteen (54.5 %) were male, mean age 58 years (range 27-80 years). 19 (57.6 %) were former or current smokers. The median Charleston co-morbidity index was 3 (range 0-7). All complained of a least one of; dyspnoea, cough, haemoptysis, or weight loss. None reported fever. Ten patients (31 %) did not have an elevated Aspergillus IgG, and only 4 patients had elevated Aspergillus precipitins. Twelve patients (36 %) had a single nodule, six patients (18 %) had between 2 and 5 nodules, 2 (6 %) between 6 and 10 nodules and 13 (39 %) had more than 10 nodules. The mean size of the nodules was 21 mm, with a maximum size ranging between 5-50 mm. No nodules had cavitation radiographically. The upper lobes were most commonly involved. Histology was available for 18 patients and showed evidence of granulation tissue, fibrosis, and visualisation of fungal hyphae.
  
  
  
  Pulmonary nodules are a less common manifestation of aspergillosis in immunocompetent patients. Distinguishing these nodules from other lung pathology may be difficult on CT findings alone.
authors.affiliation: The National Aspergillosis Centre, University Hospital of South Manchester, 2nd floor ERC, Southmoor Road, Wythenshawe, M23 9LT, UK. Eavan@esatclear.ie.|The University of Manchester and the Manchester Academic Health Service Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, UK. Eavan@esatclear.ie.
authors.forename: Eavan G
authors.initials: EG
authors.lastname: Muldoon
authors.affiliation: The Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Sharman
authors.affiliation: The National Aspergillosis Centre, University Hospital of South Manchester, 2nd floor ERC, Southmoor Road, Wythenshawe, M23 9LT, UK.|The University of Manchester and the Manchester Academic Health Service Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Page
authors.affiliation: The Department of Histopathology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Bishop
authors.affiliation: The National Aspergillosis Centre, University Hospital of South Manchester, 2nd floor ERC, Southmoor Road, Wythenshawe, M23 9LT, UK.|The University of Manchester and the Manchester Academic Health Service Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, UK.
authors.forename: David W
authors.initials: DW
authors.lastname: Denning
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001230:Aspergillus / Q000302:isolation & purification*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008168:Lung / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000382:microbiology*; D014057:Tomography, X-Ray Computed; D006113:United Kingdom
keywords: Aspergillus; Chronic pulmonary aspergillosis; Fungal infection of lung; Pulmonary nodule