Bloody foamy sputum is a foamy sputum containing a large amount of blood. The sputum is red in color. Large amounts of foamy sputum can be seen in pulmonary aspergillosis (sputum can smell like wine); pink foamy sputum is seen in pulmonary edema, etc. Chronic lung abscess, bronchiectasis, etc. may also have foamy sputum. How to diagnose pulmonary aspergillosis? I. Symptoms Patients with varicellosis have no obvious systemic symptoms, but there is gainful hemoptysis and cough. The isolated crescentic translucent area spherical foci in the lungs are its typical X-shaped manifestation. ABPA usually occurs on the basis of atopic physique and presents with recurrent episodes of wheezing, fever, cough, coughing up brown sputum clots, and hemoptysis. Physical examination shows rales in both lungs and fine wet rales in the lung infiltrates. Chest X-ray shows infiltrative lesions distributed in lobes and segments of the lungs, often wandering; solid lung lesions, or segmental or lobar atelectasis due to mucus embolization of the bronchi, then no interlobular fissure displacement, long-term recurrent attacks may lead to central bronchial dilatation, the affected segment or subsegmental bronchi are cystically dilated, while the distal end is normal. Track-like, parallel, ring-like, band-like, or toothpaste-like, finger-loop-like shadows are also often seen. Blood eosinophilia is increased. Serum IgE concentration is elevated. The intradermal test with Aspergillus leachate may show a biphasic reaction: after 15-20 minutes of test, wind and redness reactions appear and subside about 0.5-2 hours (type I reaction); after 4-10 hours of re-observation, Arthus reaction appears locally in the skin test and subside about 24-36 hours (type III reaction). Patients containing Aspergillus-specific precipitins, measured with concentrated serum specimens, had a positive rate of 92%. Patients with IPA are severely ill. There was fever, cough, coughing purulent sputum, chest pain, hemoptysis, dyspnea, and corresponding signs and symptoms caused by dissemination to other organs. Physical examination reveals dry or wet rales in the lungs, and early X-rays may show limited or bilateral multiple infiltrates, or nodular shadows, which often rapidly expand and fuse into solid necrosis to form a cavity; or sudden onset of large, wedge-shaped shadows with the bottom edge facing the pleura, resembling a “mild” pulmonary infarction. Rarely, there are signs of pleural effusion. Diagnosis Aspiration of secretions from deep bronchi, smear to find mycelium, culture repeatedly positive, help to diagnose. The typical x-ray features of Aspergillus have diagnostic significance. Positive intradermal test of Aspergillus antigen and serum precipitation test are of diagnostic value. The diagnosis of metaplastic bronchopulmonary aspergillosis can be made by aspiration of secretion smear with Aspergillus mycelium by fluoroscopy, or culture with Aspergillus growth, if it is diagnosed by episodic bronchial asthma, peripheral blood eosinophilia, elevated serum IgE, and X-ray showing foci of pulmonary infiltration. Fluoroscopic localization of lung biopsy by fluoroscopy has a confirmatory value for Aspergillus globus and invasive pulmonary aspergillosis.