Surgical Management of Symptomatic Pulmonary Aspergilloma

Battaglini, James W.; Murray, Gordon F.; Keagy, Blair A.; Starek, Peter J.K.; Wilcox, Benson R.

doi:10.1016/s0003-4975(10)61986-8

Cited by 72 publications

(44 citation statements)

References 26 publications

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“…Many patients with aspergilloma have underlying disorders or associated predisposing risk factors such as tuberculosis, necrotizing pneumonia, radiation, etc. In our series and others [1][2][3][4][5], pulmonary tuberculosis was the most common underlying predisposing factor for CPA. In a large series of 84 patients written by Babatasi et al [6], the most common underlying disease was tuberculosis in 52% of the patients.…”

Section: Discussionsupporting

confidence: 65%

“…In patient with CPA treatment following tuberculosis, dense pleural adhesions, indurated hilar structures and diseased lung parenchyma cause higher mortality rates than standard pulmonary resection (4.5-44%) [1][2][3][4][5]. Significant post-operative morbidity includes excessive hemorrhage, prolonged air leak, residual pleural space, bronchopleural fistula and empyema in up to 60% of the cases [1,6].…”

Section: Discussionmentioning

confidence: 99%

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Complex pulmonary aspergilloma treated with single stage cavernostomy and myoplasty

Gebitekin

Bayram

Akın

2005

European Journal of Cardio-Thoracic Surgery

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Objective: Complex pulmonary aspergilloma (CPA) following pulmonary tuberculosis may lead to massive and fatal hemoptysis. Pulmonary resection, as initial therapy, carries high morbidity and mortality. Resection is contraindicated in patients with compromised lung function (FEV1!40%) and in those with bilateral disease. We reviewed the results of patients undergoing single stage cavernostomy and myoplasty as an alternative therapy in patients with normal and compromised lung function. Methods: Patients suffering from recurrent massive hemoptysis (600 ml/24 h or O150 ml/h) due to CPA were selected for single stage cavernostomy and myoplasty. We performed rib resection, cavernostomy, closure of the bronchial openings and total/partial obliteration of the cavity with a muscle flap as a single stage technique in patients with CPA regardless of pulmonary function or bilateral disease. Patients began oral Itracanozole two weeks prior to surgery and continued for 3 months post-operatively. Results: Three women and four men (median age 38 years; range 24-59 years) with CPA were evaluated. Four patients had either bilateral disease or compromised lung function. Pectoralis major muscle was used for the myoplasty in five and trapezius or latissimus dorsi in the other two patients. The median number of bronchial fistulae closed during the surgery was six (range 2-12). Blood loss was minimal (median 227 ml). Two patients underwent successful re-exploration for significant air leak. The median hospital stay was 9 days (6-27days). Six patients are alive and hemoptysis free (median follow-up 57.2 months). Conclusions: Cavernostomy and myoplasty as a single stage technique is safe and reliable in the management of patients with complex pulmonary aspergilloma. Morbidity is low even in patients with compromised lung function or bilateral disease. Q 2005 Published by Elsevier B.V.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Complex pulmonary aspergilloma treated with single stage cavernostomy and myoplasty

Gebitekin

Bayram

Akın

2005

European Journal of Cardio-Thoracic Surgery

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“…Initially, the fungus adheres to the cavity wall, where it proliferates, but its own weight causes the detachment. Specific serology and cultures identify Aspergillus fumigatus in 98% of patients [5][6][7][16][17][18] . In our work, Aspergillus fumigatus was the etiologic agent in 16 cases and Aspergillus niger in one.…”

Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Complex pulmonary aspergilloma treated by cavernostomy

Silva

Marsico

Araujo

et al. 2014

Rev. Col. Bras. Cir.

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Results Results: Ten patients were male. The mean age was 42.9 years (34-56). The most frequent symptom was repeated pulmonary bleeding. Cavernostomy was proposed for patients at high risk for lung resection. It was performed in 17 patients and all of them had pulmonary tuberculosis sequelae, with cavitations. The indication in all cases was hemoptysis and elimination of phlegm. The cavernostomies were performed in a single surgical procedure. In all 17 patients the cavity was left open after the withdrawal of the mycetoma. In all patients hemoptysis ceased immediately. Operative mortality was 9.5% (1). Conclusion Conclusion Conclusion Conclusion Conclusion: cavernostomy is an effective treatment alternative in patients at high risk. It may be useful in some patients with complex aspergilloma, irrespective of lung function or bilateral disease. It is technically easy, has low-risk, saves parenchyma, and may be performed in a single operative time.

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“…The terms semi-invasive pulmonary aspergillosis [6] and chronic necrotising pulmonary aspergillosis [7] were introduced in the early 1980s. Advances in thoracic surgery, during this era, produced cures from aspergilloma in some patients with single lesions and recognition that outcomes were often poor in those with multicavity disease, termed complex aspergilloma [8,9]. Very few patients are described in the literature as being treated with amphotericin B [10], and early open trials of itraconazole, without standardised response criteria, showed partial clinical benefits without radiological change [11].…”

Section: Introductionmentioning

confidence: 99%

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Denning¹,

Cadranel²,

et al. 2015

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Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ∼240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up. @ERSpublications ERS and ESCMID guideline for the management of chronic pulmonary aspergillosis released

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Surgical Management of Symptomatic Pulmonary Aspergilloma

Cited by 72 publications

References 26 publications

Complex pulmonary aspergilloma treated with single stage cavernostomy and myoplasty

Complex pulmonary aspergilloma treated with single stage cavernostomy and myoplasty

Complex pulmonary aspergilloma treated by cavernostomy

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

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