, Volume 196, Issue 1, pp 1–10 | Cite as

Infectious and Non-Infectious Diseases Causing the Air Crescent Sign: A State-of-the-Art Review

  • Joyce Betta Sevilha
  • Rosana Souza Rodrigues
  • Miriam Menna Barreto
  • Gláucia Zanetti
  • Bruno Hochhegger
  • Edson Marchiori
State of the Art Review


Aspergilloma, also known as mycetoma or fungus ball, is characterized by a round or oval mass with soft-tissue attenuation within a preexisting lung cavity. The typical computed tomography (CT) aspect of an aspergilloma is a mass separated from the wall of the cavity by an airspace of variable size and shape, resulting in the air crescent sign, also known as the meniscus sign. This CT feature is non-specific and can be simulated by several other entities that result in intracavitary masses. This review describes the main clinical and imaging aspects of the infectious and non-infectious diseases that may present with fungus-ball appearance, including pulmonary hydatid cyst, Rasmussen aneurysm, pulmonary gangrene, intracavitary clot, textiloma, lung cancer, metastasis, and teratoma, focusing on the differential diagnosis.


Air crescent sign Aspergillosis Fungus ball Computed tomography Pulmonary diseases 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Knower MT, Kavanagh P, Chin R Jr (2002) Intracavitary hematoma simulating mycetoma formation. J Thorac Imaging 17:84–88CrossRefPubMedGoogle Scholar
  2. 2.
    Yasuda M, Nagashima A, Haro A, Saitoh G (2013) Aspergilloma mimicking a lung cancer. Int J Surg Case Rep 4:690–692CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Marchiori E, Zanetti G, Barreto MM (2015) Teratoma: another cause of the aircrescent sign. QJM 108:431CrossRefPubMedGoogle Scholar
  4. 4.
    Fred HL, Gardiner CL (2009) The air crescent sign: causes and characteristics. Tex Heart Inst J 36:264–265PubMedPubMedCentralGoogle Scholar
  5. 5.
    Franquet T, Müller NL, Giménez A, Guembe P, de La Torre J, Bagué S (2001) Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics 21:825–837CrossRefPubMedGoogle Scholar
  6. 6.
    Latgé JP (1999) Aspergillus fumigatus and aspergillosis. Clin Microbiol Rev 12:310–350PubMedPubMedCentralGoogle Scholar
  7. 7.
    Gazzoni FF, Severo LC, Marchiori E, Guimarães MD, Garcia TS, Irion KL et al (2014) Pulmonary diseases with imaging findings mimicking aspergilloma. Lung 192:347–357CrossRefPubMedGoogle Scholar
  8. 8.
    Gazzoni FF, Hochhegger B, Severo LC, Marchiori E, Pasqualotto A, Sartori AP et al (2014) High-resolution computed tomographic findings of Aspergillus infection in lung transplant patients. Eur J Radiol 83:79–83CrossRefPubMedGoogle Scholar
  9. 9.
    Louza GF, Zanetti G, Marchiori E (2017) Aspergilloma in honeycomb cysts and paraseptal emphysema: an unusual association. Arch Bronconeumol. Google Scholar
  10. 10.
    Roberts CM, Citron KM, Strickland B (1987) Intrathoracic aspergilloma: role of CT in diagnosis and treatment. Radiology 165:123–128CrossRefPubMedGoogle Scholar
  11. 11.
    Thompson BH, Stanford W, Galvin JR, Kurihara Y (1995) Varied radiologic appearances of pulmonary aspergillosis. Radiographics 15:1273–1284CrossRefPubMedGoogle Scholar
  12. 12.
    Marchiori E, Hochhegger B, Zanetti G (2016) Intracavitary nodule. J Bras Pneumol 42:309CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Sakarya ME, Özbay B, Yalcinkaya İ, Arslan H, Uzun K, Poyraz N (1998) Aspergillomas in the lung cavities. East J Med 3:7–9Google Scholar
  14. 14.
    Abramson S (2001) The air crescent sign. Radiology 218:230–232CrossRefPubMedGoogle Scholar
  15. 15.
    Malik A, Chandra R, Prasad R, Khanna G, Thukral BB (2016) Imaging appearances of atypical hydatid cysts. Indian J Radiol Imaging 26:33–39CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Gouliamos AD, Kalovidouris A, Papailiou J, Vlahos L, Papavasiliou C (1991) CT appearance of pulmonary hydatid disease. Chest 100:1578–1581CrossRefPubMedGoogle Scholar
  17. 17.
    Lewall DB (1998) Hydatid disease: biology, pathology, imaging and classification. Clin Radiol 53:863–874CrossRefPubMedGoogle Scholar
  18. 18.
    Koul PA, Koul AN, Wahid A, Mir FA (2000) CT in pulmonary hydatid disease: unusual appearances. Chest 118:1645–1647CrossRefPubMedGoogle Scholar
  19. 19.
    Garg MK, Sharma M, Gulati A, Gorsi U, Aggarwal AN, Agarwal R et al (2016) Imaging in pulmonary hydatid cysts. World J Radiol 8:581–587CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Balikian JP, Mudarris FF (1974) Hydatid disease of the lungs. A roentgenologic study of 50 cases. Am J Roentgenol Radium Ther Nucl Med 122:692–707CrossRefPubMedGoogle Scholar
  21. 21.
    Flynn JL, Chan J (2001) Tuberculosis: latency and reactivation. Infect Immun 69:4195–4201CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ruffino-Netto A (2002) Tuberculosis: the neglected calamity. Rev Soc Bras Med Trop 35:51–58CrossRefPubMedGoogle Scholar
  23. 23.
    Manzella A, Filho PB, Albuquerque E, Farias F, Kaercher J (2009) Imaging of gossypibomas: pictorial review. AJR Am J Roentgenol 193:S94–S101CrossRefPubMedGoogle Scholar
  24. 24.
    Domingos-Grando R, Zanetti G, Marchiori E (2016) Hemoptysis in tuberculosis: the importance of contrast-enhanced computed tomography. Arch Bronconeumol 52:173–174CrossRefPubMedGoogle Scholar
  25. 25.
    Keeling AN, Costello R, Lee MJ (2008) Rasmussen’s aneurysm: a forgotten entity? Cardiovasc Intervent Radiol 31:196–200CrossRefPubMedGoogle Scholar
  26. 26.
    Marchiori E, Hochhegger B, Zanetti G (2015) Intracavitary nodule in active tuberculosis: differential diagnosis of aspergilloma. J Bras Pneumol 41:562–563CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Wang W, Gao L, Wang X (2013) Rasmussen’s aneurysm with aspergilloma in old, healed pulmonary tuberculosis. Clin Imaging 37:580–582CrossRefPubMedGoogle Scholar
  28. 28.
    Castañer E, Gallardo X, Rimola J, Pallardó Y, Mata JM, Perendreu J et al (2006) Congenital and acquired pulmonary artery anomalies in the adult: radiologic overview. Radiographics 26:349–371CrossRefPubMedGoogle Scholar
  29. 29.
    Penner C, Maycher B, Long R (1994) Pulmonary gangrene. A complication of bacterial pneumonia. Chest 105:567–573CrossRefPubMedGoogle Scholar
  30. 30.
    Gold W, Vellend H, Brunton J (1992) The air crescent sign caused by Staphylococcus aureus lung infection in a neutropenic patient with leukemia. Ann Intern Med 116:910–911CrossRefPubMedGoogle Scholar
  31. 31.
    Zelefsky MN, Lutzker LG (1977) The target sign: a new radiologic sign of septic pulmonary emboli. AJR Am J Roentgenol 129:453–455CrossRefPubMedGoogle Scholar
  32. 32.
    Reich JM (1993) Pulmonary gangrene and the air crescent sign. Thorax 48:70–74CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Castaner E, Gallardo X, Mata JM (1998) Common and uncommon complications of reactivation tuberculosis in immunocompetent patients. Eur J Radiol 27:43–52CrossRefPubMedGoogle Scholar
  34. 34.
    Yella LK, Krishnan P, Gillego V (2005) The air crescent sign: a clue to the etiology of chronic necrotizing pneumonia. Chest 127:395–397CrossRefPubMedGoogle Scholar
  35. 35.
    Vlaović J, Voga G (2016) Spontaneous pulmonary hematoma in a patient with sepsis treated with dual antiplatelet therapy. Wien KlinWochenschr 128:553–556CrossRefGoogle Scholar
  36. 36.
    Bard R, Hassani N (1975) Crescent sign in pulmonary hematoma. Respiration 32:247–251CrossRefPubMedGoogle Scholar
  37. 37.
    Shorr RM, Crittenden M, Indeck M, Hartunian SL, Rodriguez A (1987) Blunt thoracic trauma. Analysis of 515 patients. Ann Surg 206:200–205CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Rijken MJ, van Overbeeke AJ, Staaks GH (2005) Gossypiboma in a man with persistent cough. Thorax 60:708CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Nomori H, Horio H, Hasegawa T, Naruke T (1996) Retained sponge after thoracotomy that mimicked aspergilloma. Ann Thorac Surg 61:1535–1536CrossRefPubMedGoogle Scholar
  40. 40.
    Machado DM, Zanetti G, Araujo Neto CA, Nobre LF, Meirelles GSP, Pereira-Silva JL et al (2014) Thoracic Textilomas. Computed tomography findings. J Bras Pneumol 40:535–542CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Nobre LF, Zanetti G, Marchiori E (2016) Textiloma: a forgotten diagnosis. Rev Port Pneumol 22:366–367PubMedGoogle Scholar
  42. 42.
    Marchiori E, Zanetti G, Hochhegger B, Machado DM (2011) Hydatid disease versus textiloma: a diagnostic challenge. Thorax 66:635CrossRefPubMedGoogle Scholar
  43. 43.
    Alberg AJ, Samet JM (2003) Epidemiology of lung cancer. Chest 123:21S–49SCrossRefPubMedGoogle Scholar
  44. 44.
    Park Y, Kim TS, Yi CA, Cho EY, Kim H, Choi YS (2007) Pulmonary cavitary mass containing a mural nodule: differential diagnosis between intracavitary aspergilloma and cavitating lung cancer on contrast-enhanced computed tomography. Clin Radiol 62:227–232CrossRefPubMedGoogle Scholar
  45. 45.
    Chaudhuri MR (1970) Cavitary pulmonary metastases. Thorax 25:375–381CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Guimaraes MD, Hochhegger B, Santos MK, Santana PR, Júnior Sousa AS et al (2015) Magnetic resonance imaging of the chest in the evaluation of cancer patients: state of the art. Radiol Bras 2015(48):33–42CrossRefGoogle Scholar
  47. 47.
    Bandoh S, Fujita J, Fukunaga Y, Yokota K, Ueda Y, Okada H et al (1999) Cavitary lung cancer with an aspergilloma-like shadow. Lung Cancer 26:195–198CrossRefPubMedGoogle Scholar
  48. 48.
    Goto T, Kato R, Maeshima A, Oyamada Y (2010) Cavitary lung cancer with an aspergilloma-like shadow. J Thorac Oncol 5:580–581CrossRefPubMedGoogle Scholar
  49. 49.
    Cavalcante BF, Zanetti G, Marchiori E (2015) Pulmonary neoplasia mimicking fungus ball. Radiol Bras 48:400–401CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Seo JB, Im JG, Goo JM, Chung MJ, Kim MY (2001) Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics 21:403–417CrossRefPubMedGoogle Scholar
  51. 51.
    Watanabe H, Uruma T, Tsunoda T, Tazaki G, Suga A, Nakamura Y et al (2014) Lung metastasis of transitional cell cancer of the urothelium, with fungus ball-like shadows closely resembling aspergilloma: a case report and review of the literature. Oncol Lett 8:95–98CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Gaeta M, Volta S, Scribano E, Loria G, Vallone A, Pandolfo I (1996) Air-space pattern in lung metastasis from adenocarcinoma of the GI tract. J Comput Assist Tomogr 20:300–304CrossRefPubMedGoogle Scholar
  53. 53.
    Barreto MM, Valiante PM, Zanetti G, Boasquevisque CH, Marchiori E (2015) Intrapulmonary mature teratoma mimicking a fungus ball. Lung 193:443–445CrossRefPubMedGoogle Scholar
  54. 54.
    Giunchi F, Segura JJ (2012) Primary malignant teratoma of lung: report of a case and review of the literature. Int J Surg Pathol 20:523–527CrossRefPubMedGoogle Scholar
  55. 55.
    Makarawo TP, Finnikin S, Woolley S, Bishay E (2009) Trichoptysis: a hairy presentation of a rare tumour. Interact Cardiovasc Thorac Surg 9:733–735CrossRefPubMedGoogle Scholar
  56. 56.
    Roig J, Aguilar X, Maestre J, Domingo C, Morera J (1991) Pulmonary mass and air meniscus sign in a 19-year-old man. Chest 100:562–563CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Federal University of Rio de JaneiroRio de JaneiroBrazil
  2. 2.Instituto D’Or para Pesquisa e EducaçãoRio de JaneiroBrazil
  3. 3.Santa Casa de Porto AlegrePorto AlegreBrazil

Personalised recommendations