To explore the clinical characteristics and diagnostic methods of pulmonary aspergillosis(PA) and improve the abilities of clinical diagnosis.

Retrospective review on clinical data of twenty-two misdiagnostic cases with pulmonary aspergillosis, which were admitted to Affiliated Hospital of Jining Medical University during January 2007 to April 2014.

Twenty-two cases of pulmonary aspergillosis patients were diagnosed as other diseases primarily, including sixteen cases(72.7%) as bacterial pneumonia, three cases (13.6%)as suspected tuberculosis and three cases (13.6%)as suspected lung cancer or pulmonary metastasis.Clinical manifestations were as follows: sixteen cases with cough and sputum, thirteen cases with gasp and dyspnea, eight cases with fever, five cases with hemoptysis, two cases with chest pain and two cases with hoarseness.White blood cells in peripheral blood were high in thirteen cases; neutrophils ratio was high in fifteen cases, c-reactive protein (CRP) increased in twelve cases and galactomannan (GM) test was positive in six cases.Chest CT scans in patients were diverse and dynamic, including nine cases with right lung lesions, two cases with left lung lesions and eleven cases with double lung lesions.There were six cases with "air crescent sign" , five cases with double lung multiple patchy shadows, five cases with mild or moderate bronchial expansion , three cases with a single or multiple nodules or masses, two cases with "halo sign" and one case with "gloves sample changes" . In addition, ten cases were accompanied with emphysema or pulmonary bullae, nine cases were accompanied with lung door and mediastinal lymph node enlargement, five cases were accompanied with multiple or single cavity and four cases were accompanied with unilateral or bilateral pleural effusion.Mycelium could be seen in sputum specimens of nine cases by deep microscopic examination, including aspergillus fumigatus in five cases, aspergillus flavus in two cases and both above aspergillus in two cases.At the same time, there were three cases of aspergillus by sputum culturing and isolating, two cases of aspergillus fumigatus and one cases of aspergillus niger by BALF culturing and isolating.There were two cases of aspergillus by the sputum and BALF fungus cultivation.Two cases were confirmed by lung biopsy under the electronic bronchoscopy, one case was confirmed by CT-guided percutaneous lung biopsy and one case was confirmed after surgery.

Pulmonary aspergillosis is a disease whose onset is insidious and clinical manifestations are atypical.The clinical early misdiagnosis rate is high, so the etiology and pathology examinations should been perfected as soon as possible to diagnose definitively.