Table 1 Definitions of chronic pulmonary aspergillosis and its subtypes

Chronic pulmonary aspergillosis

Nodular or cavitary lesion or lesions in the lung, of at least 3 months duration in a non-immunocompromised patient (or one whose immunocompromising condition has remitted or is trivial), caused by Aspergillus spp. as demonstrated on tissue section by staining, by positive culture of a percutaneous biopsy or positive Aspergillus IgG antibodies.

Aspergilloma (Fungal ball caused by Aspergillus spp.)

An approximately spherical shadow with surrounding air, also called a fungal ball, in a pulmonary cavity, with serological or microbiological evidence that Aspergillus spp. is present in the material. This is a radiological or morphological description, not a disease descriptor and is not required for the diagnosis of chronic pulmonary aspergillosis.

Simple aspergilloma

Single pulmonary cavity containing a fungal ball, with serological or microbiological evidence implicating Aspergillus spp. in a non-immunocompromised patient with minor or no symptoms and no radiological progression over at least 3 months of observation.

Aspergillus nodule

One or more nodules which may or may not cavitate are an unusual form of CPA. They may mimic carcinoma of the lung or coccidioidomycosis and can only be definitively diagnosed on histology. Tissue invasion is not demonstrated, although necrosis is frequent.

Chronic cavitary pulmonary aspergillosis (CCPA)

One or more pulmonary cavities possibly containing an aspergilloma, with serological or microbiological evidence implicating Aspergillus spp. with significant pulmonary or systemic symptoms and overt radiological progression (new cavities, increasing pericavity infiltrates or increasing fibrosis) over at least 3 months of observation.

Chronic fibrosing pulmonary aspergillosis (CFPA)

Severe fibrotic destruction of at least two lobes of lung complicating CCPA leading to a major loss of lung function. Severe fibrotic destruction of one lobe with a cavity is simply referred to as CCPA affecting that lobe. Usually the fibrosis is manifest as consolidation, but large cavities with surrounding fibrosis may be seen.

Subacute invasive aspergillosis (SAIA) or chronic necrotising pulmonary aspergillosis (CNPA) (considered the same entity)

Invasive aspergillosis, usually in mildly immunocompromised patients, occurring over 1–3 months, with variable radiological features including cavitation, nodules, progressive consolidation with ‘abscess formation’. Biopsy shows hyphae in invading lung tissue and microbiological investigations reflect those in invasive aspergillosis, notably positive Aspergillus galactomannan antigen in blood (or respiratory fluids).