In contrast to simple aspergilloma, syndromes of progressive cavitary aspergillosis are highly morbid (Fig 4). Over 30 years ago, Gefter and colleagues35 coined the term “semi-invasive aspergillosis” for this clinical entity. Since then, it has been variably referred to as “complex aspergilloma,” “chronic cavitary pulmonary aspergillosis,” “chronic necrotizing pulmonary aspergillosis,” and “subacute invasive disease.”30,36‐38 “Chronic cavitary pulmonary aspergillosis” and “chronic necrotizing pulmonary aspergillosis” have been the more commonly used terms in recent years, and many authors distinguish the two entities by cavity features, host immune status, and the degree of suspected tissue invasion.37,39 Specifically, the term “chronic necrotizing pulmonary aspergillosis” is often reserved for quickly progressing disease in patients with compromised immune function, in whom local tissue invasion is suspected. However, the terms continue to be used interchangeably in the literature, the clinical features demonstrate significant overlap, and parenchymal invasion is rarely demonstrated. Although a consensus on terminology is still lacking, we refer to this syndrome as “chronic cavitary pulmonary aspergillosis.”37 Cavities may be single or multiple, thin-walled or thick-walled, and progress in a dramatic or indolent fashion (Fig 4). Discrete mycetomas were observed in only 25% of patients in one study.40 Pleural thickening is common. Progressive pulmonary fibrosis develops in a subset of patients.37 Symptoms include dyspnea, cough, hemoptysis, chest pain, weight loss, fever, and malaise. Nonspecific serum inflammatory markers such as C-reactive protein and the erythrocyte sedimentation rate are often elevated.