Tracheobronchial Aspergillosis Mimicking Pseudotumoral Lesions in a Rare Presentation of a Known Disease

Tracheobronchial aspergillosis (TBA) is an uncommon form of invasive <i>Aspergillus</i> infection that can closely mimic endobronchial malignancy, particularly when presenting as an obstructive pseudotumoral lesion. We report the case of a 78-year-old immunocompetent male who presented with hemoptysis, progressive dyspnea, and an endobronchial mass initially suspected to represent bronchogenic carcinoma. Bronchoscopy revealed a tumor-like obstructive lesion, and both bronchoalveolar lavage (BAL) culture and bronchial biopsy culture grew <i>Aspergillus</i> spp. based on characteristic microscopic morphology. Histopathologic examination demonstrated septate hyaline hyphae with clear evidence of tissue invasion, confirming invasive fungal disease. The patient experienced marked clinical and endoscopic improvement following systemic voriconazole therapy and bronchoscopic intervention, with near-complete resolution of the lesion. This case highlights the need to consider fungal etiologies in the differential diagnosis of endobronchial masses and emphasizes the essential role of early bronchoscopy, microbiological cultures, and histopathologic evaluation in establishing a timely and accurate diagnosis.