Figure 1

Computed tomographic imaging of the chest at the level of the aortic arch in 2003, two years before dyspnea onset, showed a small cavity in the left upper lobe due to emphysematous change (a). Computed tomography 2 years after initial presentation (April 2005) showed that the cavity was increasing in size and contained a fungus ball (b). The cavity then continued to increase in size, developing a thick wall and infiltration of the surrounding areas, with increased pulmonary effusion (c: July 2005; d: October 2005; e: December 2005; f: January 2006).