This 53 y/o female with chest pain and arthralgia was referred for chest CT for evaluation of an abnormality seen on a chest x-ray. Selected images from the chest CT shown above demonstrate dense consolidation of the antero-medial right upper lobe. Repeat CT after 2 weeks of antifungal therapy demonstrates some clearing of the consolidation with early cavitation/mycoma formation. What you see isn't always what you get. The imaging key to this case is probably the blood vessels in the consolidated lung in the second image from the initial study. The history, in a patient who is a resident of Southern California, should also raise the suspicion of the diagnosis. The patient's symptoms and chest findings resolved after antifungal therapy.

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