Aspergillus species are ubiquitous soil-dwelling microorganisms found in organic debris, dust, compost, foods, spices and rotting plants. Colonization is usually as a result of the inhalation of airborne spores from an inanimate reservoir and, if spores reach the peripheral lung, a variety of clinical syndromes may develop . Although a history of previous lung resection has been described as a risk factor for infection by this fungus , few cases of BSA have been reported [1–3] since its description in 1969 as a specific clinical entity . Only five additional cases have been described [2, 3, 5] since the publication of a series of 17 cases by Noppen and colleagues  in 1995. The reported cases have usually been in immunocompetent patients and are associated with the use of silk sutures ; a suture made with nylon thread was used in only one case . Aspergillosis often appears with cough and hemoptysis [2, 3] but may also be an incidental finding .
PET-CT scans are used to distinguish metabolically active from active lesions because of the biochemical differences, especially in staging cancer . However, many positive findings have been reported in nonmalignant diseases such as tuberculosis, other infectious and granulomatous diseases and even benign schwannoma [7, 8], not only for the diagnosis but also for monitoring treatment efficacy . The present report of BSA is the first in which the diagnosis came after observing increased FDG activity on a PET-CT scan in an asymptomatic patient. This report suggests that this infection should be included in the range of diagnostic possibilities to consider when follow-up PET-CT scans are positive after lung resection.
Although it is widely suggested that the removal of persisting sutures is the treatment of choice for BSA [1–3, 5], good results have also been reported with the use of oral itraconazole as an alternative when removal was not feasible . Given the fact that no trace of suture was found during the initial bronchoscopy procedure, we prescribed antifungal therapy and the response was good.