Tomosynthesis of the lungs of a woman who previously had<unk> , showing scarring consistent with<unk>  fibrosing pulmonary<unk> . The diagnosis of<unk>  is often initially considered when patients present with a history of unintentional weight loss and fatigue. Confirmation of this suspicion is normally achieved with a combination of radiological imaging and serological testing, with the goal of excluding other diagnoses like tuberculosis and finding evidence of fungus present. Whilst cavities seen on chest X-rays can raise suspicion, positive IgG testing for Aspergillus is required for confirmation. Sputum samples can be sent for culture, but where these return negative patients should undergo bronchoscopy and bronchoalveolar lavage for further culture samples. Concurrent infections with non-tuberculous mycobacteria, or atypical infections such as MRSA or Pseudomonas aeruginosa are common and these can also form cavities. To confirm the presence of an aspergilloma, there needs to be radiological evidence of a round mass in the lungs with confirmatory evidence either from culture or IgG testing. The distinction between simple aspergilloma, and more advanced<unk>  cavitary pulmonary<unk> , will depend on the severity of inflammation, radiological evidence, and changes over time. To confirm<unk> , the current criteria is one large cavity or more than two small cavities, either with or without aspergilloma. This must be accompanied by at least one symptom of fever, weight loss, fatigue, cough, sputum production, haemoptysis or shortness of breath for at least 3 months. Furthermore, as with aspergilloma, there must be positive IgG testing but this can be with or without culture. To confirm Aspergillus nodules as opposed to aspergilloma, these must be seen directly on imaging or confirmed by percutaneous or surgical biopsy. The fibrosing form—chronic fibrosing pulmonary<unk> —has similar criteria to<unk>  cavitary pulmonary<unk>  but will be accompanied by significant fibrosis seen on either biopsy, tomosynthesis, or high resolution computed tomography. If<unk>  has progressed to subacute invasive pulmonary<unk> , there must be a degree of immunosuppression. The microbiological criteria are similar to those of invasive<unk>  but normally slower in progression, i.e. months rather than weeks. Furthermore, there must be evidence of IgG or galactomannan in the blood and a confirmatory biopsy of affected tissue.
Chronic pulmonary aspergillosis
Lung cancer
Tuberculosis
Allergic bronchopulmonary aspergillosis
Miliary tuberculosis
Primary inoculation tuberculosis
Primary pulmonary coccidioidomycosis
Extrapulmonary tuberculosis