No abstract available. Article truncated after 150 words. A 69-year-old woman, a current smoker, with very severe chronic obstructive pulmonary disease and prior atypical mycobacterium, was found unresponsive by her family and intubated in the field by emergency medical services for respiratory distress. Her CT thorax showed severe emphysematous disease, apical bullous disease, and a large left upper lobe cavitation with debris (Figure 1). She was treated with broad-spectrum antibiotics and anti-fungal medications. Hemoptysis was never seen. Sputum cultures over a span of two weeks repeatedly showed Aspergillus fumigatus and outside medical records confirmed the patient had a known history of stable aspergilloma not requiring therapy. Aspergillomas usually arises in cavitary areas of the lung damaged by previous infections. The fungus ball is a combination of colonization by Aspergillus hyphae and cellular debris. Individuals with aspergillomas are usually asymptomatic or have mild symptoms (chronic cough) and do not require treatment unless it begins to invade into the cavity ...