Radiological features of aspergillomas and surrounding areas after pulmonary tuberculosis

Abstract

Objectives: Although pulmonary tuberculosis (TB) may be effectively treated, destruction of the lung parenchyma can lead to recurrent infections including aspergilloma. Hemoptysis is a serious complication of aspergilloma. However, the relationship between aspergillomas and surrounding areas after TB has not been comprehensively investigated. Herein, CT scans were used as the primary method of investigation. Methods: A retrospective study on patients with aspergilloma was performed. Twenty patients with prior tuberculosis infections were compared with 27 individuals who had never been infected with tuberculosis. The Mann-Whitney U-test was used for direct comparison of aspergilloma volume and cavity thickness between the TB group and the non-TB group. Fisher’s exact test was used to compare aspergilloma calcification and location; perilesional ground-glass opacity (GGO), calcification, and bronchiectasis; and pleural thickening between groups. To facilitate the localization of aspergilloma, the apical and posterior segments of the upper lobe or the superior segment of the lower lobe were defined as “the golden area.” Results: A total of 76.60% patients (36/47) had a history of hemoptysis, and 13.89% (5/36) had previously experienced severe hemoptysis. Patients who had hemoptysis-associated events were significantly more likely to have considerable perilesional GGO around the aspergilloma than those who did not experience such events (77.78% vs 36.36%, P=.027). In the TB group, all aspergillomas were situated in “the golden area” (100.00% vs 77.78%, P=.031). However, no statistically significant differences were observed in aspergilloma amount or volume, or the thickness of the cavity between groups (P >.05). Furthermore, no significant differences were observed between groups regarding aspergilloma calcification, perilesional GGO, perilesional calcification, perilesional bronchiectasis, or pleural thickening (P >.05). Conclusions: Hemoptysis caused by aspergilloma is frequently encountered in clinical settings, and the presence of perilesional GGO on CT images is strongly suggestive of hemoptysis. Patients with prior tuberculosis often have aspergillomas located in “the golden area.” Images obtained from CT scans may be used to guide therapy.