Table 1– Glossary of terms
AspergillomaAn 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
Simple aspergillomaSingle 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
Chronic cavitary pulmonary aspergillosisOne or more pulmonary cavities which may or may not contain a fungal ball, with serological or microbiological evidence implicating Aspergillus spp. in a non-immunocompromised patient (or one whose immunocompromising condition has remitted or is trivial) 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. If biopsy of the affected area is performed, it demonstrates hyphae with surrounding chronic inflammation and fibrosis but not tissue invasion
Chronic fibrosing pulmonary aspergillosisSevere fibrotic destruction of at least two lobes of lung complicating chronic cavitary pulmonary aspergillosis leading to a major loss of lung function. Usually the fibrosis is in the form of consolidation, but it may be large cavities with surrounding fibrosis. Severe fibrotic destruction of one lobe with a cavity is simply referred to as chronic cavitary pulmonary aspergillosis affecting that lobe
Subacute invasive aspergillosis or chronic necrotising pulmonary aspergillosisInvasive aspergillosis, usually in mildly immunocompromised patients, occurring over 1–3 months, with marked pleitrophic radiological features (cavitation, nodules and progressive consolidation with “abscess formation”), with hyphae visible in destroyed lung tissue or inferred from microbiological investigations (i.e. positive Aspergillus antigen) and pace of disease
Acute invasive aspergillosisInvasive aspergillosis, usually in markedly immunocompromised patients, occurring over <1 month. May be angioinvasive or not. Radiological features include nodules or progressive consolidation often with a “halo” sign inferring angioinvasive disease, cavity (or air crescent) formation, pleural effusion and miliary appearance (if associated with massive spore exposure). If biopsy is performed, hyphae are visible in destroyed lung tissue. Most diagnoses inferred from typical radiological appearances on computed tomography scanning, microbiological investigations (i.e. positive Aspergillus antigen), immunocompromised status and rapid pace of disease