Other forms of aspergillosis: Aspergilloma (Fungal Ball in the Lung)

An aspergilloma is a ball of fungal material that grows inside an existing cavity in the lung. It is most often caused by Aspergillus, a common mould found in the environment.

It is not cancer, and it does not usually mean that fungus is invading healthy lung tissue. However, an aspergilloma can cause important problems, especially coughing up blood, and needs assessment by a respiratory specialist.

Key points

• An aspergilloma is a fungal ball growing inside a pre-existing lung cavity.
• It most often occurs in lungs already affected by conditions such as previous tuberculosis, COPD, sarcoidosis, bronchiectasis or prior lung surgery.
• Some people have few or no symptoms; others have cough, breathlessness or coughing up blood.
• Any coughing up of blood should be reported to your healthcare team.
• Scans, blood tests and sometimes sputum tests help doctors confirm the diagnosis and look for associated chronic pulmonary aspergillosis (CPA).
• Treatment depends on symptoms, bleeding, lung function and the wider condition of the lungs.

What is an aspergilloma?

An aspergilloma forms when fungal threads, mucus and other material collect inside a space that is already present in the lung. The space is usually a cavity left by an earlier lung problem.

The fungal ball may move within the cavity when a person changes position. It is usually identified on a chest X-ray or, more clearly, on a CT scan.

Aspergilloma is often part of the wider spectrum of chronic pulmonary aspergillosis (CPA), but not everyone with a fungal ball has progressive CPA. Specialist assessment helps establish what is happening in each individual case.

Who is at risk?

An aspergilloma can develop when a lung cavity has formed because of an earlier illness or treatment. Conditions that may leave cavities or significant lung damage include:

• Previous tuberculosis (TB) or another serious lung infection
• Chronic pulmonary aspergillosis
• COPD or emphysema
• Sarcoidosis
• Bronchiectasis
• Previous lung surgery or radiotherapy

Most people who have one of these conditions will not develop an aspergilloma.

Symptoms

Some aspergillomas cause no symptoms and are found during a scan for another reason. Others may be associated with:

• Persistent cough
• Breathlessness
• Tiredness or reduced exercise tolerance
• Repeated chest infections
• Coughing up blood, known as haemoptysis

Symptoms can also be caused by the underlying lung condition, so it is important not to assume that every symptom is caused by the fungal ball itself.

Coughing up blood: when to get help

Coughing up blood is the most important potential complication of an aspergilloma. Even small streaks of blood in sputum should be reported promptly to your respiratory team or GP, particularly if this is new or becoming more frequent.

Call 999 or go to A&E immediately if bleeding is heavy, ongoing, increasing quickly, or occurs with severe breathlessness, chest pain, faintness or a rapid deterioration in how you feel.

Do not stop or change prescribed medicines, including blood-thinning medicines, without medical advice. Tell the emergency or respiratory team about all medicines you take.

How is an aspergilloma diagnosed?

Doctors combine symptoms, scans and laboratory tests. An aspergilloma can sometimes resemble another lung problem on an X-ray or CT scan, so careful assessment is important.

Tests may include:

• A chest X-ray and CT scan
• Blood tests, including Aspergillus IgG antibodies
• Sputum culture or PCR testing where a sample can be produced
• Comparison with previous scans
• Further tests where cancer, tuberculosis, non-tuberculous mycobacterial infection or another cause needs to be excluded

Your local respiratory team may seek specialist advice when the diagnosis is uncertain, bleeding is recurrent, or treatment options are complex.

Treatment and monitoring

Treatment is tailored to the individual. Decisions depend on whether there is bleeding, the severity of symptoms, whether the fungal ball is stable on scans, lung function and whether there is associated CPA.

Monitoring

If an aspergilloma is stable and not causing significant symptoms or bleeding, regular clinical and scan follow-up may be the safest approach. Your team will advise how often this is needed.

Antifungal medicines

Antifungal treatment is not automatically needed for every simple aspergilloma. It may be considered when there is associated CPA or another reason to treat active Aspergillus-related disease.

Antifungal medicines can interact with many other drugs and often need blood tests and monitoring. The choice of medicine should be made with your specialist team.

Controlling bleeding

If bleeding is significant, doctors may use medicines and urgent procedures to control it. Bronchial artery embolisation is a procedure that blocks abnormal blood vessels supplying the area of bleeding. It can be very effective, although bleeding can sometimes recur.

Surgery

For carefully selected people, surgery to remove the cavity and fungal ball can offer the best chance of a long-term cure. It is only suitable when the likely benefit outweighs the risks, including the effect of surgery on remaining lung function.

Living with an aspergilloma

Looking after the underlying lung condition remains important. This may include taking medicines as prescribed, attending follow-up appointments, keeping up with airway-clearance treatment where relevant, and seeking help promptly for changing symptoms.

It is sensible to reduce exposure to obvious dust, damp and mould where practical, but you do not need to avoid ordinary life or outdoor activities altogether. Aspergillus spores are widespread in the environment and most people encounter them every day.

Related information

Visit the Aspergilloma (Fungal Ball) Hub

Learn about chronic pulmonary aspergillosis (CPA)
Learn about treatment for aspergillosis
Browse the Aspergillosis Knowledge Hub

References

• Brown JS, Armstrong-James D, Ayling-Smith J, et al. British Thoracic Society Clinical Statement on Aspergillus-related chronic lung disease. Thorax. 2025;80(Suppl 1):3–21.
• Patterson TF, Thompson GR, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis. Clinical Infectious Diseases. 2016;63:e1–e60.

Last reviewed: September 2026