Transcript SURGICAL TREATMENT OF PULMONARY ASPERGILLOMA Adalet Demir, Mehmet Zeki Günlüoğlu, Akif

SURGICAL TREATMENT OF
PULMONARY ASPERGILLOMA
Adalet Demir, Mehmet Zeki Günlüoğlu, Akif
Turna, Hasan Volkan Kara, Seyyid İbrahim Dinçer
Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery,
Department of Thoracic Surgery, Istanbul, TURKEY.
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Aspergilloma generally results from colonization
of an existing lung cavity (tuberculosis,
bronchiectasis, lung abcess, bulla, tumor cavity,
sarcoidosis) by Aspergillus fumigatus, the most
common saprophytic species of Aspergillus in
human disease, producing a fungus ball or a
mycetoma
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The most common symptoms are; cough,
sputum and hemoptysis.
Hemoptysis 55-91%
Massive hemoptsis 10-25%
 26% of all aspergilloma patients dies as massive
hemoptysis.
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Major hemoptysis rate of asymptomatic patients
is 20%
Treatment
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Surgery
Resection (Lobectomy, Segmentectomy, Wedge
resection, Pneumonectomy, pleuropneumonectomy)
 Cavernostomy
 Cavernostomy+myoplasty
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Embolisation
İntracavitary or endobronchial antifungal
therapy
Sistemic antifungal therapy
Radiation therapy
Medical treatment
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Some antifungal agents (itraconasole) are
not effective because of intracavitary fibrosis
Study
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1988 - 2003
41 patients
5 female, 36 male
Mean age: 42(17-70)years.
All patients underwent posteroanterior and lateral chest
radiography, computed tomography of the chest, and
fiberoptic bronchoscopy. Transthoracic fine-needle
aspiration biopsy was performed in some patients who
could not be diagnosed by other means.
All patients operated on independent of symptoms
Surgical approach is posterolateral thoracotomy.
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Degree of hemoptysis in 24 h
>300cc=massive
Prolonged air leak>7 days
Operative mortality: in 30 days or along
hospitalisation
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34 patients have preoperative diagnosis of
Aspergilloma, 7 patients have not
The most common symptom is hemoptysis
(75%). Massive hemoptysis 7%
Left upper lobe 51% (21), right upper lobe 39%
(16), right lower lobe 10% (4)
Pneumonectomy
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5 patients
1 completion pneumonectomy because of
recurrent hemoptysis in patients performed
lobectomy
2 patients with cavitary lesions in both lobes
1 patient with destroyed lung
1 patient because of technical difficulties
Morbidity and Mortality
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Postoperative morbidity rate 24.3%
 16
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complication in 10 patients
Mortality rate 2.4% (1 patient)
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performed pneumonectomy, developed
BPF, died in 48th hour because of
respiratory insufficiency
Follow up
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Mean follow up time 67 months (11-192)
Recurrent hemoptysis rate: 2,4% (1 patient)
performed completion pneumonectomy
One patient died as respiratory insufficiency at
40th month
Conclusion
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Surgical resection for aspergilloma offers
potential benefits with low morbidity and
mortality, prevention of massive hemoptysis,
eradication of the pyogenic component, and
limitation of the symptoms. However,
pneumonectomy must be avoided if possible as
it leads to increased morbidity.