Minimally invasive management of a centrally located pulmonary aspergilloma in an adolescent patient

Pulmonary aspergillosis is a fungal lung infection caused by inhalation of Aspergillus spores. While traditionally associated with immunocompromised patients, it may also develop in immunocompetent individuals. The clinical presentation is wide, varying from asymptomatic colonization to invasive disease with significant morbidity. Despite advances in antifungal therapy with agents such as voriconazole, medical treatment alone often fails to achieve complete eradication of the infection, especially in cases of aspergilloma, where a dense fungal ball forms within a pre-existing pulmonary cavity. Surgical resection remains the mainstay management of localized aspergilloma. The type of surgery and how much tissue is removed are determined by the size and location of the lesion, as well as the patient's lung function. Traditionally, these operations have been performed via thoracotomy because of the complexity of the procedure and the possibility of intra-operative bleeding. However, recent developments in minimally invasive thoracic surgery, such as video-assisted thoracoscopic surgery, combined with comprehensive multidisciplinary management, offer a safer and less morbid alternative. This case demonstrates successful integration of multidisciplinary medical management, including antifungal therapy and minimally invasive surgical resection in treating a centrally located pulmonary aspergilloma.