Pulmonary Aspergillosis is a rare clinical fungal infection of the lungs. Aspergillus is widely distributed in nature, mainly parasitic in the upper respiratory tract of human beings, due to the existence of normal people with immune defense function, usually a small amount of Aspergillus does not cause disease, when the human body’s immunity is reduced or a large number of pathogens invade the human body, it can be infected, morbidity. In recent years, due to the broad-spectrum antibiotics, cytotoxic drugs, immunosuppressants and adrenocorticotropic hormone widely used, organ transplantation, AIDS increase, as well as the incidence of tuberculosis, so that the pulmonary Aspergillosis has been increasing year by year. Clinical common for putrefactive Aspergillus fumigatus infection, the current more authoritative classification of this disease into three types: allergic pulmonary aspergillosis, invasive pulmonary aspergillosis and pulmonary aspergillosis ball. Aspergillus infection forms isolated or multiple spherical foci in the lungs, and imaging typically shows a crescent-shaped translucent area between the spherical foci and the cavity wall – the “crescent sign”, called pulmonary aspergillosis, which is the most common in clinical practice. The clinical manifestations of pulmonary aspergillus ball are various, and often secondary to the underlying lung diseases, lack of specificity, diagnosis has certain difficulties, clinical easy to miss, misdiagnosis. First, the pathogenesis and characteristics of pulmonary Aspergillus ball: Aspergillus easy to parasitize in the lung chronic diseases associated with the reproduction of the cavity, accumulation, clinical cases are mostly seen in patients secondary to underlying lung disease (such as tuberculosis cavity, tube dilatation, lung cysts). Aspergillus is mostly confined to the cystic cavity, generally does not invade the lung tissue outside the cavity, but with the progress of the disease, its ball gradually increase in size, around the formation of rich vascular network, or even the formation of hemangiomas, and its own active enzyme toxin with the erosion of blood vessels, as well as the ball of the bacterium in the cavity of the rolling, friction and other reasons, prone to cause necrosis of tissues and blood vessels, and hemorrhage. The content of Aspergillus ball is a special yellow or gray-brown, mud-like material, but brittle and fragile, poor adhesion. Aspergillus ball is surrounded by reactive fibrous tissue to form an envelope-like structure, the adjacent lung tissue is compressed and solid, and the inner wall is smooth due to the mechanical friction of Aspergillus filaments. Microscopic examination:HE staining was purple-blue PAS staining was clearer, AgNOR staining was brown-black, lymphocytes, monocytes infiltration was seen between the mycelium, intermixed with macrophages; the lung tissue around the lesion was different degrees of pulmonary atelectasis, inflammatory cell infiltration. Second, the diagnosis of pulmonary aspergillus ball: pulmonary aspergillus ball patients generally have 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 varied, lack of specificity, and the disease and tuberculosis, branch expansion and other diseases of the lesions of the same site, X-ray performance is similar, coupled with some patients and secondary on the basis of tuberculosis, resulting in clinical consideration of the progression of the primary disease and recurrence; there are also some patients with X-ray performance is extremely atypical, and the primary disease and similar; there is also a CT scan coincidentally will be the lesion omitted, the observation is not careful! The lack of awareness and vigilance on the part of clinicians to pulmonary aspergillosis has resulted in clinical cases being easily missed and misdiagnosed. The diagnosis of this disease is mainly based on clinical symptoms, mycological examination, imaging examination, fiberoptic bronchoscopy biopsy and postoperative pathological examination. When the patient has hemoptysis symptoms, and the following manifestations should be considered as the possibility of this disease: underlying lung lesions (tuberculosis, bronchiectasis, pulmonary cysts, etc.); malignant tumors, the use of corticosteroids and other immune-compromised people; lung shadows do not disappear after antibiotic treatment for a long period of time, the condition of the patient worsened; tuberculosis patients with prolonged antituberculosis treatment did not relieve the condition or aggravation of the patient. The diagnosis of this disease depends on fungal culture and histological examination, and the diagnosis can be confirmed by finding characteristic pathogens, and pathological tissue examination is decisive for diagnosis. Typical Aspergillus ball X-ray and CT features are diagnostic. Imaging (X-ray and CT examination) typical Aspergillus ball manifested as a lung cavity or cavity spherical contents, cavity wall and the contents of the crescent-shaped translucent shadow can be seen between the wall, change the position of photography or scanning, the location of the spherical contents can be changed. Typical imaging manifestations of patients often need to be identified with lung cancerous cavity, tuberculosis ball liquefaction: caseous cavity formation or tuberculosis ball lysis can form a pattern similar to the varicose ball, but the tuberculosis ball lysis is located in the side of the hilar side, which is in the shape of a small crescent, while the air band of the varicose ball is located in the upper part of the cavity; carcinoma cavity can form a peninsular sign, and the inner part of the formation of a nodular shape and so on. For atypical imaging examination, sputum culture, fiberoptic bronchoscopy or respiratory secretion smear can be performed for several times in a row, such as seeing mycelium and spores expanded at the tip like chrysanthemum can assist the diagnosis; percutaneous aspiration lung biopsy is feasible for small nodular lesions with limitation; for those who have difficulties in diagnosis, hemoptysis and other symptoms are obvious, if there is no contraindication, then they should strive for the earliest possible surgical resection of the lesion, which is both diagnostic and therapeutic. Third, the treatment of pulmonary Aspergillus ball: the treatment of this disease, at present, there are only a few antifungal drugs to Aspergillus effective, such as: amphotericin B, itraconazole; but the effectiveness of the underlying lung disease due to different efficacy of the difference is greater, due to the difficulty of the drug to reach the lung cavity to kill the Aspergillus, and antifungal drugs are more toxic; therefore, purely systemic anti-mycobacterial treatment is ineffective, there is no obvious Aspergillus ball. The efficacy of the treatment. At present, it is generally recognized that surgical treatment is the main means of treatment of pulmonary aspergillosis: regardless of symptoms, as long as the lesion is limited, malignant lesions can not be excluded, hemoptysis ineffective in internal medicine, the patient’s cardiorespiratory function can tolerate the operation should be surgical treatment, and the emergence of hemoptysis should be emergency surgery. Surgical resection of limited lesions is the main method of treating pulmonary aspergillosis, lobectomy, wedge or partial resection is the main surgical method, and chest wall resection should also be performed if the chest wall is involved. Minimally invasive surgery using thoracoscopy or thoracoscopy-assisted modified posterior posterolateral small incision, in addition to the characteristics of less trauma and quicker recovery, can also observe all parts of the thoracic cavity, which is conducive to intraoperative hemostasis, less bleeding, and quicker postoperative recovery. The incidence of surgical complications in this disease is high, and the main causes of surgical complications are: (1) patients with primary diseases, severe inflammatory reaction of the pleura near the lesion, blurring of the boundary of the lesion, and surgical difficulties; (2) abundant collateral circulation complicates the surgical process; (3) the remaining lung tissue is difficult to reexpand, which makes the patient susceptible to infection and prone to bronchopleural fistulae, pus chest, especially thickening of pleura is obvious; (4) destruction of lung parenchyma exceeding one lobe of the lung can be observed in all parts of the lung cavity, which is helpful for intraoperative hemostasis, and quick recovery. (4) destruction of lung parenchyma in more than one lobe or lesions in both lungs. Aspergillosis recurrence or dissemination is the main factor affecting the effectiveness of surgical treatment, and the need for postoperative antifungal treatment is inconclusive. It is generally believed that if the lesion is extensive or the cavity is ruptured, and there is pulmonary primary disease or other factors that may lead to the recurrence or dissemination of Aspergillus, prophylactic antifungal treatment should be given for 4 weeks, and if the lesion is isolated, completely resected during the operation, and there is no primary disease, short-term antifungal treatment can be given during and after the operation. In summary, in recent years, pulmonary aspergillosis has a tendency to increase year by year, among which pulmonary aspergillus ball is the most common. The clinical manifestations of pulmonary aspergillosis are diverse and lack of specificity, coupled with the lack of knowledge of the disease, resulting in a certain degree of difficulty in diagnosis and a high rate of clinical misdiagnosis. For those who have difficulties in diagnosis, hemoptysis and other symptoms are obvious, if there is no contraindication, then we should strive for early surgical resection of the lesion. At present, the treatment of pulmonary aspergillosis is mainly based on surgical resection of limited lesions, such as some cases with small lesions and uninvolved chest wall, the minimally invasive surgical approach of thoracoscopy or thoracoscopy-assisted small incision can be considered.