How is an aspergilloma (fungal ball) in the lung best managed when symptomatic?

• A. Observation
• B. Antifungal therapy
• C. Surgical resection
• D. Antibiotics

Answer: (C)

When a fungus ball causes symptoms, removing it surgically is the most effective approach. An aspergilloma sits inside a preexisting lung cavity and often leads to recurrent or life-threatening bleeding (hemoptysis). Surgically removing the affected portion of lung eliminates the cavity and the fungal ball, addressing the source of symptoms and the risk of massive hemorrhage.

Antifungal drugs are generally not successful here because the ball lies in a nonvascularized cavity and the organism is largely colonizing the space rather than causing invasive infection, so systemic therapy has limited effect. Observation is appropriate mainly for those without symptoms or bleeding risk, but not for symptomatic cases. Antibiotics target bacteria, not fungi, so they don’t resolve an aspergilloma. In some patients, procedures to control bleeding, like bronchial artery embolization, may be used as a bridge or palliation, but they don’t remove the fungal mass.