Surgical Treatment of Pulmonary and Pleuro-Pulmonary Aspergillus Disease

Abstract

Between 6/87 and 3/92 22 out of 24 patients were treated (22 by surgery) for pulmonary and pleural Aspergillus disease. The most frequent lung disorder was tuberculosis (9 x), followed by bronchiectasis (5 x), congenital lung cysts (2 x), pneumonia with abscess formation (2 x), sarcoidosis (2 x), and bronchial cancer (4 x). More than half the patients had further severe secondary diseases. 4 patients with "simple aspergilloma" and 5 patients with "complex aspergilloma" underwent lobectomy or segmentectomy without complications or recurrence. Special surgical problems occurred in 13 patients with inflammation involving pleura and chest wall (pleuro-pulmonary aspergillosis, pleural aspergillosis) and invasive lung changes (invasive pulmonary aspergillosis). 7 patients developed an empyema after lung resection, on 4 occasions with bronchopleural fistula. In 4 cases myoplasty, in 2 cases thoracomyoplasty, on 2 occasions completion pneumonectomy with omentoplasty, in one case omentoplasty alone, and on 2 occasions decortication with pleurectomy and lung resection lead to a complete cure. 2 open window thoracostomies were constructed. In 15 cases a single operation was adequate. In 7 patients up to 3 further operations were necessary. 17 patients had haemoptysis, in 10 of these cases it was recurrent. On 7 occasions life-threatening haemorrhage took place, causing death in 2 cases. These were the only deaths resulting from the lung disease. Our results show that aggressive surgical action can be successful. Myoplasty, thoracomyoplasty, and omentoplasty are, in our view, the most suitable measures for healing pleura empyemas and bronchopleural fistulae coincident with pleuro-pulmonary aspergillosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Bola fúngica por Aspergillus fumigatus em cavidade pleural

“…In addition, it is essential that, in an attempt to elucidate the diagnosis of pleural effusion, authors reported, in a series of 13 cases of pleural aspergilloma, only 7 cases (54%) of symptomatic patients with hemoptysis, expectoration, and chest pain, whereas the remaining cases consisted of asymptomatic patients diagnosed only by routine chest X-ray, (13) which differs from our clinical findings. In our study, similarly to another report, (16) the radiographic diagnosis showed effusion and pleural thickening in 6 patients, indicating an exudative process. However, for a definitive diagnosis of the disease, it is necessary to perform a mycological evaluation, the positivity of which is determined by the microscopic finding of septate branching hyphae arranged in the shape of an aspergilloma and by the taxonomic identification of the fungus by culture of a specimen of the pleural cavity content.…”

“…(1,7) In rare cases, an aspergilloma can be located in the pleural space, being usually subsequent to surgical complications or concomitant with the presence of a bronchopleural fistula. (10)(11)(12)(13)(14)(15)(16)(17)(18) The objective of the present study was to report and document cases of patients with pleural aspergilloma caused by Aspergillus fumigatus, determining the profile of those patients, and therefore to assist in raising clinical suspicion.…”

Aspergilloma: comparison of treatment methods and prognoses

“…Provided that patients are carefully selected (simple aspergilloma, single lesion without sequelae), such as our case 5, surgical resection offers the best chance of cure, with low mortality and morbidity. [6][7][8][9][10] However, in complex aspergilloma (with pleural or parenchymal sequelae) such as that afflicting our cases 1, 3, and 4, the prognosis is not always evaluable. Case 2 was a patient with a residual cavity complicated with aspergilloma after Klebsiella pneumonia.…”

Severe Sarcoidosis

“…[78][79][80][81] Antifungal therapy is warranted in symptomatic semi-invasive fungal disease, whereas bronchial artery embolization may be life-saving when there is recurrent major hemoptysis. Surgical mycetoma resection often has a poor outcome 81,82 and is seldom undertaken. PH due to occult left heart disease is as frequent as other forms of PH in sarcoidosis and has a much better treated outcome.…”