ABSTRACr From 1956 to 1980 85 patients were admitted to the Brompton Hospital, London, with pulmonary aspergilloma. The mean follow-up period was 8-7 years and 85% of patients were followed for five years or until death if this was earlier. There were 41 deaths, 27 from respiratory causes: 11 from pneumonia, six from chronic respiratory failure, seven after surgery for aspergilloma, and three from haemoptysis. Medical treatment alone was given to 36 patients, of whom three died of haemoptysis. Systemic antifungal treatment was given to 18 patients without benefit. Intracavitary antifungals were helpful in three out of 10 patients. Surgical resection was performed in 41 patients, of whom three (7%) died after operation and a further six (15%) developed major complications. Cavernostomy was performed in nine patients considered unfit for resection; four died after operation. Haemoptysis was absent or minor in 40 patients, of whom 19 were treated medically and 18 by resection, with similar five-year survival rates of 65% and 75%. Frank or major haemoptysis occurred in 45 patients, of whom 17 were treated medically and 23 by resection, with five-year survivals of 41% and 84% (p < 0.02). The better survival of the surgical group in this retrospective survey may have been due to the selection of patients with better lung function and more localised pulmonary disease. Our observations suggest that surgical resection for aspergilloma should be restricted to patients with severe haemoptysis and adequate pulmonary function. In patients unfit for resection cavernostomy is hazardous.Many patients with pulmonary aspergillomas suffer from haemoptysis.1-7 Episodes of haemoptysis may be treated medically or prevented by surgical resection but the choice of method is contentious.5`12We undertook a retrospective survey of 85 patients with pulmonary aspergilloma and analysed the results of medical and surgical treatment with special reference to the severity of haemoptysis. This is the largest published series of which we are aware. MethodsWe obtained case records of 85 patients admitted to the Brompton Hospital, London, with pulmonary aspergilloma from 1956 to 1980 by referring to the hospital's diagnostic index. The criteria for inclusion in the study were the presence of a rounded opacity in a pulmonary cavity on a plain chest radiograph or tomogram" and of serum precipitins to aspergillus

Hospital case notes and chest radiographs of 100 patients with Marfan syndrome were investigated for evidence of pulmonary disease. The criteria for inclusion of details of a given patient in the study were the occurrence of Marfan abnormalities in at least two separate body systems (skeletal, cardiovascular, ocular)

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The authors describe the computed tomographic (CT) appearances of aspergilloma in 26 patients. With narrow (3-mm) sections, a bone algorithm, and wide window settings, CT scans enabled accurate identification of both the forming aspergilloma as well as the mature fungus ball in 25 cases. The diagnostic accuracy of CT was confirmed histologically in nine cases. The radiologic concept of the aspergilloma as a solid mass partially surrounded by a crescent of air is no longer tenable as the only definite criterion for diagnosis. In cases in which this classic appearance is seen on CT scans, mobility is easily demonstrated with use of prone and supine positions. In other cases, the aspergilloma appears as an irregular spongework containing air spaces and filling the cavity, obliterating the air crescent sign. The fungus ball is therefore fixed and immobile. Forming aspergillomas can also be identified by the fungal strands that fall into the cavity lumen, trapping air and initiating the sponge-work appearance. The CT appearance in patients with positive precipitins is characteristic and allows earlier diagnosis than does conventional tomography.

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