Aspergilloma and massive haemoptysis

Abstract

A 40-year-old homeless woman who was a known intravenous drug user and heroin smoker, presented with massive haemoptysis. Initial CT-pulmonary angiogram (CT-PA) did not show active haemorrhage but found an opacity in a right upper lobe cavity likely to represent a mycetoma. She was started on antifungal therapy but haemoptysis persisted and bronchial angiography was performed. Again no active haemorrhage was identified but abnormal vasculature was seen supplying the right upper lobe. This was empirically embolised with particles which did not improve her symptoms. A subsequent CT-PA identified a pulmonary artery pseudoaneurysm in the cavity wall which was successfully embolised. There was no further haemoptysis and a repeat CT-PA 3 weeks later showed continuing occlusion of the pulmonary artery aneurysm. Investigations for tuberculosis were negative and she was discharged clinically well and on long-term antifungal therapy.

Endovascular management of hemoptysis in a known case of tetralogy of fallot and tuberculosis complicated with aspergilloma: a case report

“…Chronic pulmonary aspergillosis can result in moderateto-significant hemoptysis which could be life threatening and needs emergent treatment [5]. Patients with acyanotic congenital heart disease are more susceptible to common infections like pulmonary tuberculosis(TB) [6].…”

“…Aspergilloma is a form of chronic pulmonary aspergillosis that develops in a pre-existing lung cavity usually secondary to tuberculosis, sarcoidosis or bronchiectasis. The prevalence of aspergilloma in patients with pulmonary cavities secondary to pulmonary tuberculosis is 1.2 million worldwide [5] and is more common in Africa and south east Asia. Although the affected patients are mostly asymptomatic, however, moderate-to-massive hemoptysis has been reported predominantly due to hypertrophied bronchial artery and rarely secondary to pulmonary artery pseudo-aneurysm [5].…”

“…The prevalence of aspergilloma in patients with pulmonary cavities secondary to pulmonary tuberculosis is 1.2 million worldwide [5] and is more common in Africa and south east Asia. Although the affected patients are mostly asymptomatic, however, moderate-to-massive hemoptysis has been reported predominantly due to hypertrophied bronchial artery and rarely secondary to pulmonary artery pseudo-aneurysm [5]. BAE is considered as first-line therapy in emergency management of massive hemoptysis with high clinical success and low complication rates [4].…”

Massive haemoptysis secondary to mycotic pulmonary artery aneurysm in subacute invasive aspergillosis

“…Haemoptysis originating from pulmonary circulation constitutes less than 10% of the cases while a minor fraction is from microvessels and veins 5. Hence the initial work up of haemoptysis should include arterial phase CT and persistent bleeding should be investigated with CTPA 6. There are very few published case reports on significant haemoptysis secondary to PA aneurysm in invasive aspergillosis; these case reports are summarised in table 1.…”

Dual-vessel intervention treatment for massive hemoptysis caused by lung cavitary lesions

“…Bronchial artery embolization (BAE) has been known to be effective and safe in the treatment of massive hemoptysis for decades [1,2]. However, pulmonary artery embolization (PAE) sometimes needs to be carried out in the management of massive hemoptysis, especially in some cases of cavitary lesions [3,4]. The recurrence rate following BAE can be as high as 57.5% at the one-year follow-up.…”