Abstract
We describe a case of chronic pulmonary aspergillosis complicated with a slowly growing aspergilloma followed for two decades without specific intervention. It developed with no background of local or systemic immune dysfunction in a middle aged female. The case illustrates many features of this disease as well as uniquely documenting the natural radiological evolution from a small non-specific cystic lesion to a massive aspergilloma. The aspergilloma subsequently autolysed and the patient's condition changed to an allergic phenotype with development of widespread bronchiectasis and pulmonary fibrosis. We briefly discuss the range of disease aspergillus can cause in humans, its differential diagnosis and treatments.