Risk factors of severe hemoptysis in patients with fungus ball

Abstract

Background: Hemoptysis is one of the most important complications associated with fungus ball.However, the association of the primary size of the fungus ball and its change with the incidence of hemoptysis was not fully established. This study aims to determine the clinical risk factors of severe hemoptysis and natural course of fungus ball. Methods: A retrospective study on patients with fungus ball was performed. Patients with severe hemoptysis-related events were compared to those without events, and the predictors for severe hemoptysis were investigated by Cox regression analysis. Three subgroups (decreased, stable, and increased) were classified according to the long-term size change, and the severe hemoptysis-free survival duration was analyzed by the Kaplan-Meier survival curve. Results: Among 173 patients, 50 (28.9%) experienced severe hemoptysis-related events. Risk-adjusted analysis revealed that age [hazard ratio (HR), 0.964; 95% confidence interval (CI), 0.939-0.989], bloodtinged sputum [HR, 2.717; 95% CI, 1.513-4.879], and thick wall cavitary fungus balls [HR, 2.332; 95% CI, were significant predictors of severe hemoptysis-related events in patients with fungus ball. However, the baseline size of the fungus ball and its change rate were not independent risk factors for severe hemoptysis-related events. Besides, the decreased group did not have a favorable outcome in severe hemoptysis related to fungus ball. Conclusions: In a tertiary hospital, the incidence of severe hemoptysis-related events in patients with fungus ball was not low and reached 28.9%. Young patients, those with thick wall cavitary fungus ball, and those with complaints of blood-tinged sputum should be considered for early surgical treatment to prevent severe hemoptysis.

Radiological features of aspergillomas and surrounding areas after pulmonary tuberculosis

“…Calcification of the mycelial ball occurs in some cases [6,18,24], which are in agreement with our findings. In contrast, we observed no distinctions between the TB group and the non-TB group.…”

“…On the basis of the assumption that aspergilloma is an ellipsoid, the volume formula was V=4/3π (length/2 × width/2 × height/2) [6]. Visual inspection was used to estimate the cavity wall thickness.…”

“…Hemoptysis is an important complication associated with aspergilloma. In patients with aspergilloma, severe hemoptysis-associated events is common and has been reported to reach 28.9% in long-term follow-up [6]. However, the relationships between the radiological characteristics of aspergillomas and the alterations in surrounding areas as a result of prior TB have not been comprehensively confirmed.…”

Stereotactic body radiotherapy for recurrent hemoptysis due to chronic pulmonary aspergillosis: a case report and systematic review of the literature

“…fungus-infested tissue) and the tissue in its vicinity to exploit in order to protect the healthy tissue. Notably, young age, blood-tinged sputum, and thick wall cavities have been identified as independent risk factors for severe hemoptysis in patients with aspergilloma [35]. The fact that the configuration of the cavity wall but not the initial size of the fungus ball is an independent prognostic marker might also speak for the beneficial use of additional 18 F-FDG-PET/CT imaging to identify particularly eroded and inflamed parts of this critical area.…”

Chronic Pulmonary Aspergillosis: Literature Review and Demonstration of Own Observations

“…Кровохарканье и легочное кровотечение являются одним из наиболее грозных осложнений ХАЛ [62]. В группе из 60 больных с различными клинико-рентгенологическими формами ХАЛ частота кровохарканья составила 70% [52].…”