Aspergilloma (fungal ball in the lung): symptoms and treatment

Aspergillosis is a condition caused by aspergillus mould, and most types affect the lungs. The NHS explains it is usually caused by breathing in tiny bits of mould found in soil, compost, rotting leaves, dust, bedding, damp buildings and air conditioning systems. Most people who breathe in the mould do not become ill.

An aspergilloma is one form. Aspergillosis Patients and Carers Support describes it as a ball of fungal material that grows inside an existing cavity in the lung. It is not cancer and does not usually mean that fungus is invading healthy lung tissue, but it can cause important problems, especially coughing up blood.

The National Aspergillosis Centre at Wythenshawe Hospital describes aspergilloma as part of the spectrum of chronic pulmonary aspergillosis, with a simple aspergilloma being a single fungal ball growing in a cavity.

The NHS says aspergillosis is rare in healthy people and that you are usually only at risk if you have a lung condition such as asthma, cystic fibrosis or COPD, a weakened immune system, have had tuberculosis in the past, or needed ventilation after severe flu or COVID-19. Aspergillosis Patients and Carers Support adds sarcoidosis, bronchiectasis and previous lung surgery or radiotherapy as causes of cavities in which a fungal ball can develop, and stresses most people with these conditions will not develop one.

Some aspergillomas cause no symptoms and are found on a scan for another reason. Others are associated with a persistent cough, breathlessness, tiredness, repeated chest infections and coughing up blood (haemoptysis). The NHS lists aspergillosis symptoms as shortness of breath, a cough, wheezing, a high temperature, losing weight without trying and feeling tired.

Symptoms can also be caused by the underlying lung condition, so not every symptom comes from the fungal ball itself.

The NHS says to see a GP if you have a cough for more than 3 weeks or a lung condition that is getting worse, and to ask for an urgent GP appointment or get help from NHS 111 if you cough up blood. Aspergillosis Patients and Carers Support says even small streaks of blood in sputum should be reported promptly, particularly if new or becoming more frequent.

It says to call 999 or go to A&E immediately if bleeding is heavy, ongoing, increasing quickly, or occurs with severe breathlessness, chest pain, faintness or a rapid deterioration. It also says not to stop or change prescribed medicines, including blood-thinning medicines, without medical advice, and to tell the emergency team about all your medicines.

The NHS says it can be difficult to diagnose aspergillosis and may take time. A GP will check your symptoms are not caused by something else, like a chest infection, and may refer you for tests such as X-rays and scans, blood tests or tests on mucus, allergy tests and bronchoscopy.

Aspergillosis Patients and Carers Support says an aspergilloma is usually identified on a chest X-ray or, more clearly, on a CT scan, and tests may include Aspergillus IgG antibodies, sputum culture or PCR, comparison with previous scans and further tests where cancer or tuberculosis needs to be excluded. The National Aspergillosis Centre says diagnosis is difficult and often requires specialist experience, with the UK Chronic Pulmonary Aspergillosis Service based in Manchester.

The NHS lists treatment for an aspergilloma as surgery to remove the ball if it is causing symptoms, often after antifungal treatment. Aspergillosis Patients and Carers Support says treatment is tailored to the individual and depends on bleeding, symptom severity, whether the ball is stable on scans, lung function and whether there is associated CPA.

It says a stable aspergilloma causing no significant symptoms may be monitored with regular clinical and scan follow-up, and that antifungal treatment is not automatically needed for every simple aspergilloma. Bleeding may be controlled with medicines and procedures such as bronchial artery embolisation. The National Aspergillosis Centre says patients with single aspergillomas generally do well with surgery and are best given antifungals before and after the operation, that tranexamic acid can be given for bleeding if surgery is not possible, and that it is important to monitor blood levels of antifungals.

The National Aspergillosis Centre says that for most patients CPA will be a lifelong illness requiring chronic disease management, though people with a simple aspergilloma may do well after surgery if that is an option, and it quotes 84% of patients doing well post-surgery. In less than 10% of cases, it says, the disease spontaneously disappears.

The NHS adds that treatment usually aims to help control symptoms and that if aspergillosis is not treated or well controlled, there is a risk it could damage your lungs.

On the NHS, a GP can arrange initial tests and refer to respiratory or infectious disease specialists. The National Aspergillosis Centre in Manchester provides specialist advice and referral for chronic pulmonary aspergillosis.

Private respiratory consultations and CT scans can speed up assessment, but antifungal monitoring and complex decisions about surgery or embolisation are specialist matters. Share any private findings with your NHS team.