Presentation
Patient presented to ED with chronic cough.
Patient Data
Well defined rounded density within the right middle lobe. There appears to be an air-crescent sign within the lesion suggesting an aspergilloma (mycetoma).
Within the right middle lobe there is a spherical soft tissue attenuating rounded mass surrounded by a crescent of air (Monad sign).
Note surrounding bronchiectatic changes.
Post-VATS right middle lobe resection.
Pathology report of VATS specimen. Consistent with Aspergilloma.
Case Discussion
Note that the central mass is mobile. On the erect chest x-ray, the crescent of air is seen to be superior to the mass. However, on the CT images where the patient is supine the crescent of air is seen to be anterior of the mass.