Pulmonary Aspergilloma - Clinical Findings and Surgical Treatment

Abstract

The management of pulmonary aspergilloma is still a topic of discussion. Demonstrating several cases of pulmonary aspergilloma, their clinical course and their follow-up, we try to contribute some arguments for the preference of an early operation. Between 1992 and 1998, 18 patients underwent thoracotomy for treatment of pulmonary aspergilloma. The most common indication for operation were hemoptysis [6] and indeterminate mass [6]. Lobectomy was the most frequent operation [11]. Underlying diseases were bronchiectasis [10], tuberculosis [3], carcinoma [2], blebs [2], and epitheloid granuloma. Two patients had postoperative complications, another three died later in the clinical course because of liver failure, septicemia, and persisting air leakage and sepsis. We recommend early resection of symptomatic, cavitating aspergilloma in the simple form and even with an inflammatory reaction of the surrounding tissue. Especially low-risk patients profit highly from an early operation. High-risk patients should be operated on only in cases of life-threatening complications.

Predictors of Postoperative Complications After Radical Resection for Pulmonary Aspergillosis

“…13,15 Recent investigators reported a morbidity rate of 25% and a mortality rate of 5% after surgery, although the classification of postoperative complications varied (Table 4). 12,13,[16][17][18][19][20][21] The complications were massive pleural bleeding, bronchopleural fistula, empyema, and prolonged air leakage. Hypervascularization of the bronchial or intercostal arteries caused by chronic infection and dead space problems from the underlying lung disease may be related to these complications.…”

“…In conclusion, although the surgical treatment of asymptomatic aspergilloma is still controversial, 23 pulmonary aspergillosis should be resected before the symptoms become severe if the patient is a surgical candidate. 18 18 28% 18% Babatasi 13 84 27% 4% Park 19 110 24% 1% Al-Kattan 20 20 25% 5% Kurul 21 59 32% 3% Kim 12 88 27% 1%…”

Treatment of fungal infections in adult pulmonary and critical care patients

“…Нередко после эмбо лизации наблюдается повторное легочное кровотече ние, что требует консультации торакального хирурга. Оптимальным лечением в такой ситуации является хирургическая резекция, но это связано с высокой летальностью (класс рекомендаций ВII) [238][239][240][241]. Хирургические вмешательства не всегда возможны из за сопутствующей патологии и низкой легочной функции.…”

Post-primary Pulmonary Tuberculosis

“…It may occur in 11% of patients with a chronic tuberculous cavity, and approximately 25%-55% of patients with aspergilloma have a history of the disease (Kim et al 2001). Patients with aspergilloma are often asymptomatic but may present with hemoptysis (Kaestel et al 1999). Plain radiography of the chest may depict a mobile, rounded mass with air-crescent ring (Fig.23.26b and 23.37a,b).…”