Chronic necrotizing pneumonia may be the manifestation of anaerobic lung infection, tuberculosis, chronic necrotizing aspergillosis, actinomycosis, norcardiosis, and histoplasmosis. The development of pulmonary gangrene in such patients limits the possibilities to tuberculosis or chronic necrotizing aspergillosis. The absence of acid-fast bacilli and the presence of Aspergillus species in bronchial secretions in this setting allow for a diagnosis of chronic necrotizing pulmonary aspergillosis and the institution of itraconazole therapy. The high morbidity and mortality of the disease is in part due to delayed diagnosis, with a reported average delay of up to 7 months in several series.6 To ensure prompt diagnosis, Aspergillus infection must be considered when faced with a chronic necrotizing pneumonia, especially with radiographic features of ischemic necrosis, ie, lung gangrene. The need to be familiar with the radiographic and CT signs of pulmonary gangrene therefore cannot be overemphasized, and the air crescent sign remains a useful diagnostic clue.