World Journal of Cardiovascular Surgery, 2013, 3, 108-110 http://dx.doi.org/10.4236/wjcs.2013.33020 Published Online July 2013 (http://www.scirp.org/journal/wjcs) Aspergilloma in a Pulmonary Hydatid * Nikhil Tiwari # , Ramesh Kaushik, Gaurav Kumar, Gautam Ganguly, Shabaz Hasnain Department of Cardiothoracic Surgery, Military Hospital (CTC), Pune, India Email: # nikhil1972@rediffmail.com Received May 6, 2013; revised June 13, 2013; accepted June 22, 2013 Copyright © 2013 Nikhil Tiwari et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Aspergilloma infection in the lung can occur in preexisting cavities and is usually seen after tuberculosis, pulmonary infarction and bronchestasis. Occassionally aspergilloma has been reported within a hydatid cyst. We describe a patient with aspergilloma formed within cyst hydatid. The primary symptom in this patient was recurrent hemoptysis. In this 42-year-old male, the diagnosis was established by HRCT chest. Treatment consisted of postero-lateral thoracotomy with a bilobectomy of lower and middle lobe. Aspergilloma is an unusual complication of hydatid cyst and results from the deterioration of local defence against opportunistic infections. Keywords: Tuberculous Cavity; Lung Hydatid Cyst; Aspergilloma 1. Introduction Pulmonary aspergilloma generally complicates an exist- ing cavity that was due to tuberculosis; however, it can develop in any kind of pulmonary cavity. Regnard et al. reported growth of aspergilloma in a post-tuberculosis cavity in 69% in their series [1] and rarely in hydatid cyst cavities [2]. A review of literature shows isolated case reports with aspergilloma invading residual cavities left after cystectomy in lung hydatid [3,4]. Julio C. Vasquez et al. in their article recommend anatomic lung resection for such cases. A positive diagnosis relies on direct iden- tification of Aspergillus species or serodiagnosis. A se- rodiagnosis is almost always positive in chronic infec- tions and is detected by immunoelectrophoresis or a sin- gle precipitation with catalase activity. The rarity of as- pergilloma within hydatid cyst probably occurs due to the different elective site for the two diseases. The de- velopment of aspergilloma on cyst residual cavities can occur in the early post-operative period and alternatively after many years. The coexistence of hydatid cyst and aspergillosis is extremely rare [5,6] and such an associa- tion has been reported in both immunocompromised and immunocompetent patients. 2. Case Report 44 yrs old male presented to us with a history of recur- rent bouts of cough with haemoptysis. He gave a history of a diffuse right sided chest pain. He was a nonsmoker, had undergone a six month course of ATT two years back for pulmonary Koch. His clinical examination was not contributory. A chest roentgenogram (Figure 1) re- vealed a cavity in the right mid zone (RMZ) with promi- nent vascular markings. A high resolution CT (Figure 2) revealed a soft tissue mass in superior segment of the right lower lobe with a thin crescentric lucency which changes with patient’s position suggestive of aspergil- loma with adjacent lung consolidation. Bilateral pleural thickening was also noted. A fibreoptic bronchoscopy re- vealed a normal tracheobronchial tree. Fungal stains & culture, Gram stains, pyogenic culture, AFB & MTB cultre & a Polymerase chest reaction (PCR) of bron- Figure 1. CXR: Cavity within the RMZ & RLZ consolida- tion. * Conflict of interest: Authors have no conflict of interest. # Corresponding author. Copyright © 2013 SciRes. WJCS