Aspergilloma (Fungal Ball in the Lung)

An aspergilloma is a clump of fungus (usually Aspergillus) that grows inside an old cavity in the lung. These cavities often form after conditions like tuberculosis (TB), other lung infections, or lung disease. The fungus does not usually invade healthy lung tissue, but it uses the cavity as a space to grow.

How common is aspergilloma?

• Aspergillomas are uncommon overall, but they are more likely to appear in people who have had tuberculosis in the past.

• In some countries where TB is (or was) common, aspergillomas are found quite frequently.

• In countries like the UK, they are rare, but can still happen in people with conditions such as COPD, sarcoidosis, or after lung surgery.

• Doctors often describe aspergilloma as part of the wider group of conditions called chronic pulmonary aspergillosis (CPA).

What are the symptoms?

• Many people with an aspergilloma have very few symptoms at first – sometimes only a cough.

• The most serious problem is bleeding from the lungs (haemoptysis). This can range from small streaks of blood in the sputum to heavy, life-threatening bleeding.

• Some people may also have chest infections, breathlessness, or tiredness if other lung problems are present.

How is it found?

• An aspergilloma usually shows up on a chest scan (X-ray or CT).

• It often looks like a round “ball” inside a cavity in the upper part of the lung.

• Sometimes it can move around a little inside the space.

• Important note: Aspergillomas are not cancer, but they can sometimes be mistaken for cancer on scans. For this reason, doctors may arrange extra tests (such as blood tests, repeat scans, or sometimes biopsy) and may refer patients to the National Aspergillosis Centre (NAC) to be certain of the diagnosis.

Who looks after you?

• At your local hospital, aspergillomas are usually managed by a respiratory (chest) specialist doctor.

• Depending on your situation, they may also work with:

  • Thoracic surgeons (for possible surgery)

  • Radiologists (for scans or embolisation)

  • Infectious diseases doctors (for antifungal treatment)

• If your case is complex, unclear, or high-risk, your local team can refer you to the National Aspergillosis Centre (NAC) at Wythenshawe Hospital, Manchester. NAC is the UK’s only NHS specialist centre for aspergillosis and provides expert diagnosis, advanced testing, and treatment advice, often working alongside your local hospital team.

What is the outlook (prognosis)?

• Some aspergillomas remain stable for years and cause very few problems.

• A small number may even disappear on their own, although this is unusual.

• The main risk is serious bleeding, which can be sudden. This is why regular check-ups are important.

• Surgery to remove the part of lung with the aspergilloma is usually the most effective treatment and can be curative in suitable patients.

• For people who cannot have surgery, treatments such as blocking bleeding vessels (embolisation) or instilling antifungal medicine into the cavity can sometimes help, but problems may return.

🚨 Emergency: If you cough up blood 🚨

• Small streaks of blood (mild):

  • Stay calm – these often stop by themselves.

  • Contact your hospital team promptly to let them know.

  • Keep a record of how much and how often it happens.

• More than a few teaspoons, clots, or ongoing bleeding (moderate to heavy):

  • Call 999 (UK) or go to A&E immediately.

  • Sit upright to help protect the other lung.

  • Take this leaflet or your aspergillosis care details with you.

• Very heavy bleeding (life-threatening):

  • Treat this as an emergency.

  • Emergency doctors may use medicine to help blood clot, a procedure to block the bleeding vessel (embolisation), or surgery if possible.

⚠️ Always report any bleeding to your doctor, even if it seems small.

Treatment options

• No treatment may be needed if the aspergilloma is small, not causing bleeding, and the person feels well. Regular monitoring is important.

• Surgery is the most effective treatment if the fungal ball is causing repeated or heavy bleeding.

• Antifungal tablets are sometimes used before or after surgery, but on their own they are usually not very effective.

• Tranexamic acid – a medicine that helps the blood clot – is sometimes prescribed to reduce or control bleeding. It can be taken by mouth or given in hospital if bleeding is significant. It does not remove the aspergilloma but can help keep bleeding under control.

• Other treatments for people who cannot have surgery include:

  • Blocking the bleeding blood vessels (embolisation) – this can stop bleeding, but the effect may not last.

  • Instilling antifungal medicine directly into the cavity – less common, results vary.

Key points for patients

• An aspergilloma is not cancer, but because it can sometimes look like cancer on scans, careful checks and sometimes referral to the NAC are needed.

• The main risk is bleeding, which may require urgent treatment.

• Surgery offers the best chance of cure, but only if lung function allows.

• If you have an aspergilloma, you should:

  • Attend regular hospital check-ups.

  • Report any coughing up of blood immediately.

  • Take tranexamic acid if prescribed for bleeding, but also inform your doctor if bleeds occur.

  • Avoid blood-thinning medicines (like aspirin, ibuprofen, or some herbal remedies) unless your doctor prescribes them.