Asymptomatic Pulmonary Aspergillosis
The type of pulmonary aspergillosis that occurs after inhalation of aspergillus spores via the respiratory tract depends on the immunity of the host. The more serious the immunity is compromised, the more likely the occurrence of pulmonary aspergillosis is and the more serious the symptoms are. In cases with hyperactive immune response, allergic bronchopulmonary aspergillosis occurs in patients with asthma and cystic fibrosis. In cases with competent immune response, only planting or temporary residence of aspergillus occurs. Therefore, asymptomatic or slightly symptomatic pulmonary aspergillosis commonly occurs in hosts with competent immunity or slightly suppressed immunity. And the most common type of pulmonary aspergillosis is simplex pulmonary aspergilloma, followed by subacute invasive pulmonary aspergillosis (also known as chronic necrotizing pulmonary aspergillosis). Radiology may demonstrate both with air crescent sign, which indicates the diagnosis. However, subacute invasive pulmonary aspergillosis is radiologically characterized by infiltration opacity around cavity as well as thick and irregular cavity wall. Pathologically, subacute invasive pulmonary aspergillosis is demonstrated as invasion of aspergillus hyphae into lung tissue, while pulmonary aspergilloma only grows in cavity or dilated bronchus and does not invade the lung tissue. The symptoms of simplex pulmonary aspergilloma are slight or absent. But if patients show hemoptysis, it indicates vascular invasion. Serum and bronchoalveolar lavage fluid (BALF) GM test shows a higher positive rate to subacute invasive pulmonary aspergillosis than to simplex pulmonary aspergilloma, which is related to their invasiveness.
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