Topical treatment of life threatening haemoptysis from aspergillomas.

Abstract

Background -The efficacy oftopical treatment of 12 episodes of severe life threatening haemoptysis from a pulmonary aspergilloma in 11 patients is reviewed. Methods -A retrospective review was performed on five white and six AfricanAmerican patients of mean age 49 years. The underlying diseases were bronchiectasis, sarcoidosis, tuberculosis, or histoplasmosis. The patients were prospectively considered poor surgical risks because they had a forced expiratory volume in one second (FEV1) of <50% predicted and an arterial oxygen tension (Pao2) of <7*95 kPa breathing room air. As surgical intervention was not possible, local intracavitary instillation of sodium or potassium iodide was performed. Two patients were previously treated with amphotericin B. In one patient sodium iodide alone was used and in the remaining eight potassium iodide alone was instilled. The transcricothyroid approach was used in six patients and the percutaneous approach in five. Results -Haemoptysis ceased within 72 hours in all patients after the instillation of sodium or potassium iodide. There was no morbidity or mortality, and side effects included slight irritation on instillation of the iodide solution and occasional cough which was easily controlled. All patients were alive at least one year later.Conclusion -Intracavitary treatment is a viable option in the poor risk patient with life threatening haemoptysis from an aspergilloma. (Thorax 1996;51:253-255) Keywords: haemoptysis, Aspergillus, topical treatment.Haemoptysis is the most common complication of a pulmonary aspergilloma occurring in up to 74% of cases.' Massive haemoptysis (> 600 ml/24 hours) has been fatal in 28% of these patients.2 Surgical resection remains the treatment of choice for patients with adequate pulmonary reserve. 12 Even in cases with a good pulmonary reserve, 5% of patients in one series died of complications after surgery and 15% of the survivors developed significant haemorrhage and bronchopleural fistulae.3 There are many patients whose general medical condition precludes surgical resection and topical treatment with various drugs has been attempted.

Many faces of pulmonary aspergillosis

“…RUMBAK and KOHLER [80] treated 11 patients with 12 episodes of massive haemoptysis (>600 mL blood·24 h -1 ). These patients had advanced lung disease and were unsuitable for pulmonary resection (FEV1 <50% predicted).…”

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

“…Several clinical reports have described the resolution of aspergilloma through the instillation of antifungal agents into pulmonary cavities, when systemic use of antifungals is ineffective or prevented by adverse events [104][105][106][107][108][109][110][111][112][113]. Instillation of antifungal agents may be delivered through an endobronchial catheter under bronchoscopic guidance, via a percutaneous transthoracic needle or catheter placed into the aspergilloma cavity.…”

Management of end-stage sarcoidosis: pulmonary hypertension and lung transplantation

“…In medical centres where the technology is available, bronchial artery embolisation under radiographic guidance can be attempted to control the bleeding. Direct instillation of amphotericin B or a saturated solution of potassium iodide into the cavity may also be associated with decreased bleeding and is an alternative option for patients who are poor surgical candidates [87,88].…”