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The frequency of lung cancer detection in the Manchester Lung Health Checks (MLHCs), a community-based screening service, was higher than in the National Lung Screening Trial (NLST) over two screening rounds. We aimed to identify the potential reasons for this difference.We analyzed individual-level data from NLST and MLHCs, restricting to MLHCs participants who met NLST eligibility criteria. We calculated 'detection ratios' comparing the frequency of lung cancer detection in MLHCs vs NLST, first after excluding NLST participants ineligible by MLHC eligibility criteria (6-year lung cancer risk ≥ 1.51 %), and then after standardization to remove the influence of different distributions of baseline lung cancer risk.Among the 1,079 MLHCs participants who met NLST eligibility criteria, 4.7% were diagnosed with lung cancer over two screening rounds compared with 1.7% in NLST, giving an initial detection ratio of 2.6 (95%CI 2.2-3.0). This was reduced to 2.2 (95%CI 1.3-2.3) after imposing the MLHCs eligibility criterion on NLST, and further to 1.6 (95%CI 1.2-2.1) after removing the influence of different risk distributions. In stratified analyses, the standardized detection ratio was particularly elevated in individuals who were older, living in areas of high socioeconomic disadvantage, or had an FEV/FVC ratio less than 60.The 2.6-fold higher lung cancer detection in the community-based MLHCs vs NLST is partly explained by differences in eligibility criteria and baseline risk distributions. The residual 60% increase may relate to higher detection in certain risk groups, including older participants, those with more obstructive lung disease, and those living in areas of socioeconomic disadvantage.

INTRODUCTION: Low-dose CT (LDCT) screening reduces lung cancer specific mortality. Several countries, including the UK, are evaluating the clinical impact and cost-effectiveness of LDCT screening using the latest evidence. In this paper we report baseline screening performance from five UK-based lung cancer screening programmes.METHODS: Data was collected at baseline from each screening programme. Measures of performance included prevalence of screen detected lung cancer, rate of surveillance imaging for indeterminate findings and surgical resection rates. Screening related harms were assessed by measuring false positive rates, number of invasive tests with associated complications in individuals without lung cancer and benign surgical resection rates.RESULTS: A total of 11,148 individuals had a baseline LDCT scan during the period of analysis (2011 to 2020). Overall, 84.7% (n = 9,440) of baseline LDCT scans were categorised as negative, 11.1% (n = 1,239) as indeterminate and 4.2% (n = 469) as positive. The prevalence of screen detected lung cancer was 2.2%, ranging between 1.8% and 4.4% for individual programmes. The surgical resection rate was 66% (range 46% to 83%) and post-surgical 90-day mortality for those with lung cancer 1.2% (n = 2/165). The false positive rate was 2% (n = 219/10,898) and of those with a positive result, one in two had lung cancer diagnosed (53.3%). An invasive test was required in 0.6% (n = 61/10,898) of screening attendees without lung cancer; there were no associated major complications or deaths. The benign surgical resection rate was 4.6% (n = 8/173), equating to 0.07% of the screened population.DISCUSSION: The performance of UK-based lung cancer screening programmes, delivered within or aligned to the National Health Service, compares favourably to published clinical trial data. Reported harms, including false positive and benign surgical resection rates are low. Ongoing monitoring of screening performance is vital to ensure standards are maintained and harms minimised.

Background In March 2020, the UK Intercollegiate General Surgery Guidance on COVID-19 recommended that patients undergoing emergency abdominal CT should have a complementary CT chest for COVID-19 screening. Purpose To establish if complementary CT chest was performed as recommended, and if CT chest influenced surgical intervention decision. To assess detection rate of COVID-19 on CT and its correlation with RT-PCR swab results. To determine if COVID-19 changes is reliably detected within the lung bases which are usually imaged in standard abdominal CT. Methods Patients with acute abdominal symptoms presenting to a single institution between 1st and 30th April 2020 who had abdominal CT and complementary CT chest were retrospectively extracted from Computerised Radiology Information System. CT COVID-19 changes were categorised according to British Society of Thoracic Radiology reporting guidance. Patient demographics (age and gender), RT-PCR swab results and management pathway (conservative or intervention) were recorded from electronic patient records. Statistical analyses were performed to evaluate any significant association between variables. p values ≤0.05 were regarded as statistically significant. Results Compliancy rate in performing complementary CT chest was 92.5% (148/160). Thirty-five patients (35/148,23.6%) underwent intervention during admission. There was no significant association (p = 0.9085) between acquisition of CT chest and management pathway (conservative vs intervention). CT chest had 57% sensitivity (CI 18.41% to 90.1%) and 100% specificity (CI 92% to 100%) in COVID-19 diagnosis. Three of ten patients who had classic COVID-19 changes on CT chest did not have corresponding changes in lung bases. Conclusion Compliance with performing complementary CT chest in acute abdomen patients for COVID-19 screening was high and it did not influence subsequent surgical or interventional management., Highlights • Complementary CT chest in acute abdomen patients was recommended by the Royal colleges in April 2020 for COVID-19 screening. • This did not influence patient management pathway (conservative/intervention), p=0.9085. • CT chest had moderate sensitivity (57%) in diagnosis of COVID-19 in this patient cohort. • COVID-19 changes were not consistently seen within lung bases normally included on a standard abdominal CT. • Our institution has stopped performing complementary CT chest with emergency CT abdomen and pelvis.

IntroductionLow-dose CT (LDCT) screening of high-risk smokers reduces lung cancer (LC) specific mortality. Determining screening eligibility using individualised risk may improve screening effectiveness and reduce harm. Here, we compare the performance of two risk prediction models (PLCOM2012 and Liverpool Lung Project model (LLPv2)) and National Lung Screening Trial (NLST) eligibility criteria in a community-based screening programme.MethodsEver-smokers aged 55–74, from deprived areas of Manchester, were invited to a Lung Health Check (LHC). Individuals at higher risk (PLCOM2012 score ≥1.51%) were offered annual LDCT screening over two rounds. LLPv2 score was calculated but not used for screening selection; ≥2.5% and ≥5% thresholds were used for analysis.ResultsPLCOM2012 ≥1.51% selected 56% (n=1429) of LHC attendees for screening. LLPv2 ≥2.5% also selected 56% (n=1430) whereas NLST (47%, n=1188) and LLPv2 ≥5% (33%, n=826) selected fewer. Over two screening rounds 62 individuals were diagnosed with LC; representing 87% (n=62/71) of 6-year incidence predicted by mean PLCOM2012 score (5.0%). 26% (n=16/62) of individuals with LC were not eligible for screening using LLPv2 ≥5%, 18% (n=11/62) with NLST criteria and 7% (n=5/62) with LLPv2 ≥2.5%. NLST eligible Manchester attendees had 2.5 times the LC detection rate than NLST participants after two annual screens (≈4.3% (n=51/1188) vs 1.7% (n=438/26 309); padjOR 2.50, 95% CI 1.11 to 5.64; p=0.028).ConclusionProspective comparisons of risk prediction tools are required to optimise screening selection in different settings. The PLCOM2012 model may underestimate risk in deprived UK populations; further research focused on model calibration is required.

BackgroundCOPD is a major cause of morbidity and mortality in populations eligible for lung cancer screening. We investigated the role of spirometry in a community-based lung cancer screening programme.MethodsEver smokers, age 55–74, resident in three deprived areas of Manchester were invited to a ‘Lung Health Check’ (LHC) based in convenient community locations. Spirometry was incorporated into the LHCs alongside lung cancer risk estimation (Prostate, Lung, Colorectal and Ovarian Study Risk Prediction Model, 2012 version (PLCOM2012)), symptom assessment and smoking cessation advice. Those at high risk of lung cancer (PLCOM2012 ≥1.51%) were eligible for annual low-dose CT screening over two screening rounds. Airflow obstruction was defined as FEV1/FVCResults99.4% (n=2525) of LHC attendees successfully performed spirometry; mean age was 64.1±5.5, 51% were women, 35% were current smokers. 37.4% (n=944) had airflow obstruction of which 49.7% (n=469) had no previous diagnosis of COPD. 53.3% of those without a prior diagnosis were symptomatic (n=250/469). After multivariate analysis, the detection of airflow obstruction without a prior COPD diagnosis was associated with male sex (adjOR 1.84, 95% CI 1.37 to 2.47; p1/FVC ratio (adjOR 4.19, 95% CI 2.95 to 5.95; padjOR 2.80, 95% CI 1.60 to 8.42; p=0.002).ConclusionsIncorporating spirometry into a community-based targeted lung cancer screening programme is feasible and identifies a significant number of individuals with airflow obstruction who do not have a prior diagnosis of COPD.

Objectives: The impact of lung cancer screening on smoking is unclear, especially in deprived populations who are underrepresented in screening trials. The aim of this observational cohort study was to investigate whether a community-based lung cancer screening programme influenced smoking behaviour and smoking attitude in socio-economically deprived populations. Material and Methods: Ever-smokers, age 55–74, registered at participating General Practices were invited to a community-based Lung Health Check (LHC). This included an assessment of respiratory symptoms, lung cancer risk (PLCOm2012), spirometry and signposting to stop smoking services. Those at high risk (PLCOM2012≥1.51%) were offered annual low-dose CT screening over two rounds. Self-reported smoking status and behaviour were recorded at the LHC and again 12 months later, when attitudes to smoking were also assessed. Results: 919 participants (51% women) were included in the analysis (77% of attendees); median deprivation rank in the lowest decile for England. At baseline 50.3% were current smokers. One-year quit rate was 10.2%, quitting was associated with increased baseline symptoms (adjOR 2.62, 95% CI 1.07–6.41; p = 0.035) but not demographics or screening results. 55% attributed quitting to the LHC. In current smokers, 44% reported the LHC had made them consider stopping, 29% it made them try to stop and 25% made them smoke less whilst only 1.7% and 0.7% said it made them worry less about smoking or think it acceptable to smoke. Conclusions: Our data suggest a community-based lung cancer screening programme in deprived areas positively impacts smoking behaviour, with no evidence of a ‘licence to smoke’ in those screened.

Lung cancer screening with low-dose CT (LDCT) is already available in certain parts of the world, such as the United States, but not yet in Europe. The recently published European position statement on lung cancer screening has recommended planning for implementation of screening to start within 18-months [1]. Pilot European programmes are already underway, primarily in the United Kingdom (UK), delivering lung cancer screening to their local populations. This review article acknowledges the evidence base for LDCT screening and will discuss the challenges that still need to be overcome in an attempt to answer the question: are we ready to implement in Europe?

INTRODUCTION: Patients with suspected lung cancer require computed tomography (CT), specialist interpretation of the CT and a consultation with a specialist. Significant time savings could be made with rapid access to these components in the front end of the lung cancer pathway.METHODS: The RAPID programme was launched at Manchester's Wythenshawe Hospital in April 2016. This pathway offers next working day CT for patients with suspected lung cancer, immediate 'hot' reporting of CT images and a same day consultation with a diagnostic specialist.RESULTS: From April 2016 to January 2019, 1,027 patients were referred to the RAPID programme. The median time from referral to CT was 3 days. The CT was hot reported in 94% of patients. The median time from CT to triage and consultation with a diagnostic specialist was 0 days. Overall 56% and 90% of patients had completed a CT and consultation within 3 and 7 days of referral, respectively (0% and 24% prior to implementation).CONCLUSION: Through simple reorganisation of workload, we have significantly reduced the pathway for patients with suspected lung cancer to meet a specialist with a reported CT, something we firmly believe is replicable across all hospitals.

Low-dose CT (LDCT) screening of high-risk smokers reduces lung cancer (LC) specific mortality. Determining screening eligibility using individualised risk may improve screening effectiveness and reduce harm. Here, we compare the performance of two risk prediction models (PLCOEver-smokers aged 55-74, from deprived areas of Manchester, were invited to a Lung Health Check (LHC). Individuals at higher risk (PLCOPLCOProspective comparisons of risk prediction tools are required to optimise screening selection in different settings. The PLCO

Manchester’s ‘Lung Health Check’ pilot utilised mobile CT scanners in convenient retail locations to deliver lung cancer screening to socioeconomically disadvantaged communities. We assessed whether screening location was an important factor for those attending the service. Location was important for 74.7% (n=701/938) and 23% (n=216/938) reported being less likely to attend an equivalent hospital-based programme. This preference was most common in current smokers (27% current smokers vs 19% former smokers; AdjOR 1.46, 95% CI 1.03 to 2.08, p=0.036) and those in the lowest deprivation quartile (25% lowest quartile vs 17.6% highest quartile; AdjOR 2.0, 95% CI 1.24 to 3.24, p=0.005). Practical issues related to travel were most important in those less willing to attend a hospital-based service, with 83.3% citing at least one travel related barrier to non-attendance. A convenient community-based screening programme may reduce inequalities in screening adherence especially in those at high risk of lung cancer in deprived areas.

Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis (TB), with high 5-year mortality. We measured CPA prevalence in this group. 398 Ugandans with treated pulmonary TB underwent clinical assessment, chest radiography and Aspergillus-specific IgG measurement. 285 were resurveyed 2 years later, including computed tomography of the thorax in 73 with suspected CPA. CPA was diagnosed in patients without active TB who had raised Aspergillus-specific IgG, radiological features of CPA and chronic cough or haemoptysis. Author-defined CPA was present in 14 (4.9%, 95% CI 2.8–7.9%) resurvey patients. CPA was significantly more common in those with chest radiography cavitation (26% versus 0.8%; p, Chronic pulmonary aspergillosis complicates tuberculosis frequently enough to represent a global public health issue http://ow.ly/sYRO30nhg8t

Background The European position on lung cancer screening (LCS) recommends planning for implementation of low-dose computer tomography (LDCT) screening for lung cancer (LC) to start. The Manchester LCS pilot is one of the first NHS screening implementation programmes to take place and publish results. In this abstract we share results from the first incidence round of screening. Methods Details of the baseline round of the Manchester LCS pilot have been previously published.1 In brief, ever smokers, aged 55–74, from deprived areas were invited to a free ‘Lung Health Check’ (LHC) in mobile units located at their local shopping centres. The PLCOm2012 LC risk model was incorporated into the LHCs and those at high risk (PLCOm2012 ≥1.51%) were invited for annual screening starting with an immediate LDCT in a co-located mobile scanner. At baseline, 1384 individuals were screened and 3% had LC diagnosed (80% early stage, I-II). In the second round of screening, the first incidence round, all individuals screened at baseline with no subsequent diagnosis of LC (screening or non-screening) were invited back for an annual LDCT at the same community location. Exclusion included death, other malignancies and CT thorax within 3 months of due screening date. National and GP registries were checked for interval LC diagnosis. Results A total of 1,194 LDCT scans were performed as part of the second round of screening. 29 (2.4%) individuals received a positive scan result of which 19 (1.6%) were diagnosed with LC. 79% of LCs were early stage (I-II). The false positive rate was 0.8% of the screened population and 35% of those with a positive scan result. There were no interval LCs diagnosed at one year. Overall, 61 individuals (4.4%) have been diagnosed with LC (80% early stage) in the first 12 months of the Manchester LCS programme. Conclusion Annual LDCT screening of high risk individuals in this real world LCS implementation pilot continues to identify a significant number of early stage lung cancers amenable to curative treatment. No interval lung cancers were diagnosed between rounds suggesting the baseline selection criteria for screening was appropriate. Reference Crosbie PA, Balata H, et al. Implementing lung cancer screening: Baseline results from a community-based ‘Lung Health Check’ pilot in deprived areas of Manchester. Thorax2018.

Introduction Total Lung capacity (TLC) is often measured in patients with advanced lung disease to help inform diagnosis, severity and management. However, some may not manage or tolerate the technical aspects of the gold standard test: whole body plethysmography (Pleth-TLC). N2 washout (N2W-TLC) is often used in lieu but it is unreliable in obstructive conditions and some still find it challenging. As all potential lung transplant candidates undergo thoracic CT during their workup, we hypothesised that CT estimates of total lung volume (CT-TLV) could substitute Pleth-TLC and are superior to N2W-TLC. Methods Prospectively collected data between April 2015–2018. 1–2 mm CT slices were analysed using Vitrea software (version 6.1.1169.10077, Vital Solutions, Toshiba Medical Systems Europe) by a single radiologist. Descriptive statistics were compared with parametric tests. Agreement and bias between methods were examined with Pearson’s correlation and Bland and Altman analysis. Results 202 patients were studied (94 female, mean [SD] age 52 [11] yrs, BMI 25.0 [4.2] kg/m2, COPD/IPF/CF/other n=72/45/21/64). 37 (18.3%) and 50 (24.8%) were unable to perform Pleth and N2W respectively. Paired data were available for comparison of CT vs Pleth (n=160), CT vs N2W (147) and Pleth vs N2W (131), with subgroup analysis into obstructive, restrictive and normal ventilation. Mean [SD] CT-TLV, Pleth-TLC and N2W-TLC were 4.69 [1.95], 5.20 [2.06] and 4.32 [1.71] L respectively, p Conclusion CT estimates of TLC reliably approximate Pleth-TLC and could replace body box measurement in practice, for patient convenience and cost containment. Gastro-oesophageal air, captured by Pleth but not CT, accounts for some of the underestimation. The consistent small bias with a reliable homoscedastic difference between these methods may allow incorporation of a correction factor and wider application of this CT algorithm.

Chronic pulmonary aspergillosis (CPA) complicates pulmonary tuberculosis (TB). 5-year mortality is 50-85%. Prevalence is estimated at 1.3 million cases worldwide, but had not been measured. We have completed the first survey of CPA prevalence and the first survey of residual CT thorax and chest X-ray (CXR) pathology in an African population with treated TB. CT thorax is infrequently available in resource-poor settings. We calculate the accuracy of CXR for identification of CPA and CT-proven pathology. 285 patients with treated TB were assessed in 2012 and 2014. Each underwent repeat clinical assessment, CXR and Aspergillus-specific IgG measurement. CT thorax was performed in those with positive serology or suspected fungal ball on CXR. CPA was diagnosed in those without active TB and 1 - cough or haemoptysis ≥ 1 month, 2 - Paracavitary fibrosis or fungal ball on CT thorax or progressive cavitation on CXR and 3 – Raised Aspergillus-specific IgG. 14 (4.9%) patients had CPA. CXR was less accurate than CT thorax, with considerable variation between reporters. Negative predictive value of CXR cavitation for CPA diagnosis was 99.1%. CXR cavitation, + chronic symptoms + serology had 85.7% sensitivity and 99.6% specificity for CPA. CPA commonly complicates TB. CXR can exclude CPA, but serology is needed for confirmation. Accuracy of chest X-ray in relation to CT thorax (n=73)

We report results from the second annual screening round (T1) of Manchester’s ‘Lung Health Check’ pilot of community-based lung cancer screening in deprived areas (undertaken June to August 2017). Screening adherence was 90% (n=1194/1323): 92% of CT scans were classified negative, 6% indeterminate and 2.5% positive; there were no interval cancers. Lung cancer incidence was 1.6% (n=19), 79% stage I, treatments included surgery (42%, n=9), stereotactic ablative radiotherapy (26%, n=5) and radical radiotherapy (5%, n=1). False-positive rate was 34.5% (n=10/29), representing 0.8% of T1 participants (n=10/1194). Targeted community-based lung cancer screening promotes high screening adherence and detects high rates of early stage lung cancer.

Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in populations eligible for lung cancer screening. The aim of this study was to determine whether a brief CV risk assessment, delivered as part of a targeted community-based lung cancer screening programme, was effective in identifying individuals at high risk who might benefit from primary prevention. Methods: The Manchester Lung Screening Pilot consisted of annual low dose CT (LDCT) over 2 screening rounds, targeted at individuals in deprived areas at high risk of lung cancer (age 55–74 and 6-year risk ≥1.51%, using PLCOM2012 risk model). All participants of the second screening round were eligible to take part in the study. Ten-year CV risk was estimated using QRISK2 in participants without CVD and compared to age (±5 years) and sex matched Health Survey for England (HSE) controls; high risk was defined as QRISK2 score ≥10%. Coronary artery calcification (CAC) was assessed on LDCT scans and compared to QRISK2 score. Results: Seventy-seven percent (n=920/1,194) of screening attendees were included in the analysis; mean age 65.6 ± 5.4 and 50.4% female. QRISK2 and lung cancer risk (PLCOM2012) scores were correlated (r = 0.26, p < 0.001). Median QRISK2 score was 21.1% (IQR 14.9–29.6) in those without established CVD (77.6%, n = 714/920), double that of HSE controls (10.3%, IQR 6.6–16.2; n = 714) (p < 0.001). QRISK2 score was significantly higher in those with CAC (p < 0.001). Screening attendees were 10-fold more likely to be classified high risk (OR 10.2 [95% CI 7.3–14.0]). One third (33.7%, n = 310/920) of all study participants were high risk but not receiving statin therapy for primary CVD prevention. Discussion: Opportunistic CVD risk assessment within a targeted lung cancer screening programme is feasible and is likely to identify a very large number of individuals suitable for primary prevention.

We report baseline results of a community-based, targeted, low-dose CT (LDCT) lung cancer screening pilot in deprived areas of Manchester. Ever smokers, aged 55–74 years, were invited to ‘lung health checks’ (LHCs) next to local shopping centres, with immediate access to LDCT for those at high risk (6-year risk ≥1.51%, PLCOM2012 calculator). 75% of attendees (n=1893/2541) were ranked in the lowest deprivation quintile; 56% were high risk and of 1384 individuals screened, 3% (95% CI 2.3% to 4.1%) had lung cancer (80% early stage) of whom 65% had surgical resection. Taking lung cancer screening into communities, with an LHC approach, is effective and engages populations in deprived areas.

A 47-year-old patient was injured in a bomb blast and sustained trauma due to multiple fragments of shrapnel from a terrorist explosive device. We report on the surgery required to safely remove a piece of shrapnel from the anterior wall of the main pulmonary artery (PA). A chest X-ray revealed a left-sided haemothorax. A computed tomography scan confirmed the trajectory and position of a metal bolt that had lodged between the main PA and the aortic arch. At surgery, a limited left anterior thoracotomy was performed initially. A significant quantity of blood was observed in the pericardium, and the incision was extended to perform a hemi-clamshell incision with a transverse division of the sternum. Cardiopulmonary bypass (CPB) was initiated before prizing the shrapnel from a haematoma involving the front wall of the main PA. The use of the CPB prevented uncontrolled haemorrhage, and the injury to the wall was successfully repaired. The patient subsequently developed acute respiratory distress syndrome and required a prolonged period of ventilation but made a full recovery after multiple further surgeries to remove the shrapnel from his neck and legs, having been injured by 11 pieces of the shrapnel in total.

Poster: "ECR 2018 / C-1574 / CT staging for suspected lung cancer; should we routinely image the pelvis? " by: " E. E. Barclay , R. M. Duerden, A. Sharman, R. Booton, M. Evison; Manchester/UK"

PURPOSE: To determine whether it is possible to select patients with obstructive hydrocephalus, in the under 1 age group for endoscopic third ventriculocisternostomy (ETV) using pre-operative T2 weighted turbo spin echo (T2W-TSE) sagittal sequence Magnetic Resonance (MR) imaging; and to assess ventriculocisternostomy patency using post-operative T2W-TSE MR.PATIENTS AND METHODS: A retrospective review of MR examinations and clinical notes of 11 patients under 1 year of age who had ETV, was performed. The post-operative flow MR images were divided into the presence or absence of flow-related signal changes.RESULTS: In 6 of the 11 patients, ETV was successful (54.5%) i.e. no VP shunt or revision of the ETV was required. 9 patients had post-operative T2W-TSE MR examinations - 8 of these 9 MR studies correlated to the clinical situation (89%). The remaining MR examination showed a CSF flow void but the ETV failed at 3 weeks. CONCLUSION: Pre-operative MR using T2W-TSE to select suitable candidates for ETV improves the success rate from < 40% to 54.5%. Post-operatively MRI is a good predictor of whether the ETV has been successful or not.Sharman, A. (2000). Clinical Radiology55, 989. Copyright 2000 The Royal College of Radiologists.

A report on the Keystone Symposium on 'Human Genetics and Genomics', Breckenridge, Colorado, USA, 31 March to 6 April, 2001.

A meeting report from the Santa Cruz Developmental Biology Meeting, University of California at Santa Cruz, USA, July 21-25, 2000.

Background: There are a number of different manifestations of pulmonary aspergillosis. This study aims to review the radiology, presentation, and histological features of lung nodules caused by Aspergillus spp. Methods: Patients were identified from a cohort attending our specialist Chronic Pulmonary Aspergillosis clinic. Patients with cavitating lung lesions, with or without fibrosis and those with aspergillomas or a diagnosis of invasive aspergillosis were excluded. Demographic, laboratory, and clinical data and radiologic findings were recorded. Results: Thirty-three patients with pulmonary nodules and diagnostic features of aspergillosis (histology and/or laboratory findings) were identified. Eighteen (54.5 %) were male, mean age 58 years (range 27-80 years). 19 (57.6 %) were former or current smokers. The median Charleston co-morbidity index was 3 (range 0-7). All complained of a least one of; dyspnoea, cough, haemoptysis, or weight loss. None reported fever. Ten patients (31 %) did not have an elevated Aspergillus IgG, and only 4 patients had elevated Aspergillus precipitins. Twelve patients (36 %) had a single nodule, six patients (18 %) had between 2 and 5 nodules, 2 (6 %) between 6 and 10 nodules and 13 (39 %) had more than 10 nodules. The mean size of the nodules was 21 mm, with a maximum size ranging between 5-50 mm. No nodules had cavitation radiographically. The upper lobes were most commonly involved. Histology was available for 18 patients and showed evidence of granulation tissue, fibrosis, and visualisation of fungal hyphae. Conclusion: Pulmonary nodules are a less common manifestation of aspergillosis in immunocompetent patients. Distinguishing these nodules from other lung pathology may be difficult on CT findings alone.