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DESCRIPTIONAn initial CT scan of the chest of a 73-year-old man showed an incidental 22-mm-wide cavitating lesion with a central small mass in the left upper lobe of his lung. He had a history of persistent cough with minimal expectoration for many years and was breathless on exertion. He never had haemoptysis. He had a history of tuberculosis (TB) from his childhood and had asthma. He had minimal change nephropathy diagnosed in 2000, of which he had several relapses over the past 9 years, responding to steroids. On examination, he Images in… was found normal. Bronchial brushings showed fungal elements and blood tests confirmed Aspergillus.He developed a left-sided chest discomfort and increased cough and sputum production whenever he lied on his back or left side, but with no haemoptysis. On review of the CT scan, it was demonstrated that the cavity containing the aspergilloma was connected to the left main bronchus, which would explain these slightly unusual symptoms (figures 1 and 2).

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