Pulmonary aspergillosis is a rare clinical fungal infection of the lungs. Aspergillus is widely distributed in nature, mainly in the human upper respiratory tract, due to the existence of normal people with immune defense, usually a small amount of Aspergillus does not cause disease, when the human immune system or a large number of pathogens invade the human body, can cause infection, disease. In recent years, due to the widespread use of broad-spectrum antibiotics, cytotoxic drugs, immunosuppressants and adrenocorticotropic hormones, organ transplants, AIDS, and the increase in the incidence of tuberculosis, pulmonary aspergillosis has been increasing year by year. The clinical common is Aspergillus fumigatus infection, the current more authoritative typing of the disease into three types: metaplastic pulmonary aspergillosis, invasive pulmonary aspergillosis and pulmonary aspergillosis. Pulmonary Aspergillus infection forms isolated or multiple spherical lesions in the lungs, and the typical imaging manifestation is a crescent-like translucent area between the spherical lesions and the cavity wall – “crescent sign”, called pulmonary aspergillosis, which is the most common in clinical practice. The clinical manifestations of pulmonary aspergillosis are diverse, and often secondary to the underlying lung disease, lack of specificity, the diagnosis is difficult, the clinical easy to miss, misdiagnosis. A, the pathogenesis and characteristics of pulmonary Aspergillus ball Aspergillus is easy to parasitize in the cavity of the lung chronic diseases associated with multiplication, accumulation, clinical cases are mostly seen in patients with secondary to the underlying lung pathology. Aspergillus is mostly confined to the cavity, generally does not invade the lung tissue outside the cavity, but as the disease progresses, its spheres gradually increase in size, the surrounding can form a rich vascular network, and even the formation of hemangioma, its own production of active enzymes toxins with the characteristics of erosion of blood vessels, as well as the bacteria ball in the cavity rolling, friction and other reasons, easy to cause necrosis and bleeding of tissue and blood vessels. Aspergillus globule contents of its body is more special earth yellow or gray-brown, mud-like material, but brittle and fragile, poor adhesion. The Aspergillus ball is surrounded by reactive fibrous tissue forming an envelope-like structure, the adjacent lung tissue is compressed solid, and the inner wall is smooth due to mechanical friction of Aspergillus filaments. Microscopic examination: HE staining is purple-blue PAS staining is clearer, AgNOR staining is brown-black, lymphocytes, monocytes infiltration between mycelium, interspersed with macrophages; lung tissue around the lesion is different degrees of pulmonary atelectasis, inflammatory cell infiltration. Second, the diagnosis of pulmonary aspergillosis pulmonary aspergillosis patients generally no obvious systemic symptoms, the most common clinical symptoms to hemoptysis is the most common, there are literature statistics hemoptysis accounted for 91%, cough accounted for 80%, chest pain accounted for 80%, fever accounted for 30%. The clinical manifestations of pulmonary aspergillosis are diverse and lack specificity, and the lesions of this disease and pulmonary tuberculosis, bronchial expansion and other diseases have the same site of origin and similar x-ray performance, coupled with the secondary development of some patients on the basis of pulmonary tuberculosis, leading to clinical consideration of the progression and recurrence of the primary disease; there are also some patients with extremely atypical x-ray performance, and the primary disease is similar; there are also CT scans coincidentally missed the lesions, not carefully observed In some cases, the lesions may be missed on CT scan or not carefully observed, and the clinicians may not be aware of pulmonary aspergillosis and are not vigilant enough, which may lead to missed diagnosis and misdiagnosis in clinical cases. The diagnosis of this disease is currently based on clinical symptoms, fungal examination, imaging, fiberoptic bronchoscopic biopsy and postoperative pathological examination. This disease should be considered when the patient has hemoptysis symptoms and the following manifestations: underlying lung lesions (tuberculosis, bronchiectasis, pulmonary cysts, etc.); malignant tumors, use of corticosteroids and other immunocompromised people; shadows in the lungs that do not disappear after long-term antibiotic treatment, but the condition worsens; patients with tuberculosis whose condition does not remit or worsens after long-term anti-tuberculosis treatment. The diagnosis of the disease depends on fungal culture and histological examination, and the diagnosis can be confirmed by finding the characteristic pathogens, and pathological tissue examination is decisive for the diagnosis. Typical Aspergillus ball X-ray and CT features have diagnostic significance. Imaging (X-ray and CT examination) typical Aspergillus globus manifests as a lung cavity or cavity spherical contents, between the cavity wall and the contents can be seen crescent-shaped transillumination shadow, changing the position of photography or scanning, the position of the spherical contents can change. Patients with typical imaging manifestations often need to be distinguished from carcinomatous cavities and liquefied tuberculosis spheres: caseous cavity formation or tuberculosis sphere lysis can form a shape similar to that of a varicose sphere, but tuberculosis sphere lysis is mostly located on the hilar side of the lung and has a small crescent shape, while the air band of a varicose sphere is mostly located above; carcinomatous cavities can form a peninsula sign, nodular shape inside, etc. For the imaging examination is not typical, sputum culture, fiberoptic bronchoscopy or respiratory secretion smear can be performed several times, such as mycelium and apical expansion of the spores such as chrysanthemum can assist in the diagnosis; for small nodular lesions manifested as limited percutaneous needle aspiration lung biopsy is feasible; for those with diagnostic difficulties, hemoptysis and other symptoms are obvious, such as no contraindications, should strive for early surgical excision of the lesion, both diagnostic and therapeutic role. Third, the treatment of pulmonary aspergillus ball about the treatment of this disease, currently there are only a few antifungal drugs for Aspergillus effective, such as: amphotericin B, Itraconazole; but the effectiveness of the different lung underlying disease efficacy varies greatly, because the drug is difficult to reach the lung cavity to kill Aspergillus, and antifungal drugs are more toxic; so pure systemic antifungal treatment is not effective, no significant effect on Aspergillus ball . At present, the clinical consensus is that surgical treatment is the main means of treatment of pulmonary aspergillosis: regardless of the presence or absence of symptoms, as long as the lesion is limited, malignant lesions cannot be ruled out, hemoptysis in which medical treatment is ineffective, and the patient’s cardiopulmonary function can tolerate surgery should be treated surgically, and emergency surgery should be performed in the presence of hemoptysis. Surgical resection of limited lesions is the main method of treatment for pulmonary aspergillosis. Lobectomy, wedge or partial resection is the main surgical approach, and chest wall resection should also be performed if the chest wall is involved. Minimally invasive surgery using thoracoscopy or thoracoscopy-assisted modified posterior lateral small incision is not only less invasive and faster recovery, but also allows observation of all parts of the chest cavity, which is conducive to intraoperative hemostasis, less bleeding and faster postoperative recovery. The main reasons for the high incidence of surgical complications in this disease are: (1) patients with primary disease, severe inflammatory reaction in the pleura near the lesion, blurred lesion boundaries, and surgical difficulties; (2) abundant collateral circulation complicating the surgical procedure; (3) difficulty in reopening the remaining lung tissue, making the patient susceptible to infection and prone to bronchopleural fistula and pustular chest, especially with significant pleural thickening; (4) (4) destruction of lung parenchyma in more than one lobe or in both lungs. The recurrence or spread of Aspergillosis is the main factor affecting the outcome of surgical treatment, and there is no definite conclusion whether antifungal treatment is needed after surgery. It is generally accepted that: if the lesion is extensive or ruptured cavity, there is pulmonary primary disease or other susceptible to recurrence or dissemination of Aspergillus, prophylactic antifungal therapy should be given for 4 weeks, if the lesion is isolated, intraoperative complete resection, no primary disease, intraoperative and postoperative short-term antifungal therapy can be given. In summary, pulmonary aspergillosis has been increasing year by year in recent years, with pulmonary aspergillosis being the most common. Pulmonary aspergillosis has a variety of clinical manifestations, lack of specificity, coupled with the lack of knowledge of the disease causes some difficulties in diagnosis, the clinical misdiagnosis rate is high. For those who have difficulty in diagnosis, hemoptysis and other symptoms are obvious, if there are no contraindications, then we should strive to remove the lesion as soon as possible. At present, the treatment of pulmonary aspergillosis is mainly based on surgical excision of limited lesions, such as some cases with small lesions and uninvolved chest wall, can be considered for treatment by minimally invasive surgery with thoracoscopy or thoracoscopy-assisted small incisions.