Outcomes of surgery for different types of chronic pulmonary aspergillosis: results from a single-center, retrospective cohort study

Chang-ming, Shen; Qiao, GaoFeng; Wang, Cheng; Jin, Feng; Zhang, YunZeng

doi:10.1186/s12890-022-01836-z

Cited by 11 publications

(14 citation statements)

References 32 publications

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“…Jewkes et al described a 5-year survival of 84% in this group who underwent surgical resection compared to 41% who were managed with medical therapy alone. In comparison there was no reported difference in survival between the groups in patients who are asymptomatic (75% versus 65% respectively) (25,26). These results remain similar in more recent studies with a 5-year survival rate post surgery of 85-93% (22,27).…”

Section: Surgical Treatmentsupporting

confidence: 83%

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Surgical management of pulmonary aspergilloma

Garner¹,

Brunswicker²

2023

Shanghai Chest

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Pulmonary aspergillomas occur due to the aspergillus fungus colonising pre-existing cavities within the lungs of patients with underlying lung pathology or in those who are immunosuppressed. Their clinical presentation can be variable and they often present to the surgical clinic after patients develop haemoptysis. This haemoptysis can vary from mild bleeds to catastrophic life-threatening haemorrhage.Surgery for patients with aspergillomas historically carried a high morbidity and mortality impact and so the role of surgery was usually saved for patients presenting with severe haemoptysis. In recent years further research has demonstrated a reduction in the morbidity and mortality impact of surgery and therefore the question has been raised whether surgical intervention should be offered at an earlier stage. Surgery for pulmonary aspergilloma is technically challenging and does still carry a marked morbidity and mortality risk.Although these risks have reduced in recent years, surgery should still be reserved for symptomatic patients with a significant risk of further bleeding. A multi-disciplinary framework is crucial to offer best risk; benefit assessment and discussion for this high-risk patient group. This article will describe the natural history and presentations of aspergillomas, the indications and types of surgery as well as a multi-disciplinary approach to patient assessment.

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Section: Surgical Treatmentsupporting

confidence: 83%

“…Surgical resection has been shown to greatly benefit patients who have had recurrent and significant haemoptysis associated with an aspergilloma (25). Jewkes et al described a 5-year survival of 84% in this group who underwent surgical resection compared to 41% who were managed with medical therapy alone.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Surgical management of pulmonary aspergilloma

Garner¹,

Brunswicker²

2023

Shanghai Chest

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“…PET-CT of most pulmonary Aspergillus nodules shows low to medium fluorodeoxyglucose (FDG) uptake. 2 , 15 Case 5 underwent PET-CT, which showed increased FDG uptake. Aspergillus nodules are easily misdiagnosed as lung malignancies.…”

Section: Discussionmentioning

confidence: 99%

Five cases of pulmonary Aspergillus nodules diagnosed at surgery and by pathology in immunocompetent patients, with a literature review

Dong,

Wang,

Jin

et al. 2024

Therapeutic Advances in Rare Disease

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A pulmonary Aspergillus nodule is a rare subtype of chronic pulmonary aspergillosis. The diagnosis is difficult and is histological. There are only a few reports on such cases. Here, we report five cases of pulmonary Aspergillus nodules confirmed by surgery and pathology in immunocompetent patient and review the literature. Among the five patients in this group, three were females and two were males, aged 44–73 years old. Two cases had hemoptysis onset, and three cases were found to have a slow disease course on chest CT during imaging, ranging from months to years. The white blood cell count, carcinoembryonic antigen, and blood Galactomannan (GM) tests in five cases were all within normal range. Four cases had normal blood C-reactive protein, and one case had an increase. On imaging, there were two cases in the upper lobe of the right lung, two cases in the lower lobe of the left lung, one case in the upper lobe of the left lung, three cases were solitary nodular shadows, and two cases were nodular shadows with cavity formation, including one case with calcification, four cases with bronchial dilation shadows, and one case with gas containing cavity shadows. Five cases were treated with surgical resection and confirmed by histopathological examination. All five patients did not receive antifungal treatment after surgery, and there was no recurrence of Aspergillus nodules during regular follow-up.

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“…Moreover, the management of aspergillomas is both medical and surgical [18]. Small, simple aspergillomas can be managed with wedge resection, while larger simple aspergillomas or chronic cavitary aspergillomas may require a lobectomy or pneumonectomy [19]. Also, a cavernostomy and limited thoracoplasty are preferable for high-risk patients with extensive disease who may not tolerate anatomical resections [19].…”

Section: Discussionmentioning

confidence: 99%

“…Small, simple aspergillomas can be managed with wedge resection, while larger simple aspergillomas or chronic cavitary aspergillomas may require a lobectomy or pneumonectomy [19]. Also, a cavernostomy and limited thoracoplasty are preferable for high-risk patients with extensive disease who may not tolerate anatomical resections [19]. A bronchial artery embolization may stabilize patients with significant hemoptysis before surgery [20].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Aspergilloma in a Young Immunocompetent Female: A Rare Clinical Dilemma

Rasheed¹,

McCloskey²,

Foroutan³

et al. 2022

Cureus

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Depending on the host's immunological and respiratory systems, Aspergillus can induce infectious and allergic diseases. Most of the spread occurs in immunocompromised people, whereas aggressive disorder in immunocompetent patients is unusual. We report the case of a 19-year-old female who had shortness of breath, right-sided chest discomfort, and intermittent hemoptysis for six months before being diagnosed with pulmonary aspergilloma. The initial chest x-ray revealed a massive right pneumothorax and a 7.2 cm rounded opacity in the right lower lung. A subsequent computed tomography (CT) chest with contrast revealed a 6.7 cm cavitating mass occupying the right lower lobe. An open right thoracotomy and right lower lobectomy showed a cavitary fungus ball with septate branching hyphae and subsequent methenamine silver staining consistent with Aspergillus in conjunction with a positive Aspergillus antigen. We strongly suggest that pulmonary aspergillosis should be suspected regardless of age or immunocompetence in patients with prolonged cough, hemoptysis, unilateral chest discomfort, and pneumothorax.

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Outcomes of surgery for different types of chronic pulmonary aspergillosis: results from a single-center, retrospective cohort study

Cited by 11 publications

References 32 publications

Surgical management of pulmonary aspergilloma

Surgical management of pulmonary aspergilloma

Five cases of pulmonary Aspergillus nodules diagnosed at surgery and by pathology in immunocompetent patients, with a literature review

Pulmonary Aspergilloma in a Young Immunocompetent Female: A Rare Clinical Dilemma

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