Spore Wars: A Comprehensive Review of Pulmonary Aspergilloma and Its Clinical Management.

Pulmonary aspergilloma is characterized by a fungal ball that forms in a preexisting lung cavity. Although many patients remain asymptomatic, others may develop progressive symptoms including cough, hemoptysis, weight loss, fever, and, in severe cases, death. Management is often complex and highly patient-centered, ranging from routine surveillance in stable patients to invasive procedural or surgical approaches in those with more severe disease. Systemic antifungal therapy is generally not indicated for stable, asymptomatic simple aspergilloma but may be considered in select scenarios such as symptomatic or progressive disease in nonsurgical candidates, periprocedural/perioperative settings, or when overlapping chronic pulmonary aspergillosis phenotypes (eg, chronic cavitary pulmonary aspergillosis) are suspected. However, despite the significant morbidity and mortality associated with pulmonary mycetoma, there is a paucity in our understanding of their natural course, optimal treatment modalities and duration, appropriate follow-up plan, and prognostication. Consequently, clinical decision-making is frequently based on clinician experience or institutional protocols. In this article, we provide a comprehensive review of pulmonary aspergilloma and its management, with the goal of presenting a practical and evidence-based framework to support clinicians in the evaluation and treatment of this chronic fungal disease.