Bronchoscopic Removal of a Large Intracavitary Pulmonary Aspergilloma

Stather, David R.; Tremblay, Alain; MacEachern, Paul; Chee, Alex; Dumoulin, Elaine; Tourin, Olga; Gelfand, Gary; Mody, Christopher H.

doi:10.1378/chest.12-0400

Cited by 11 publications

(7 citation statements)

References 15 publications

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“…5,7,93 Removal of a simple aspergilloma by interventional bronchoscopy without surgery had favourable outcome in an elderly patient unfit for surgery. 94 In a retrospective series of 89 surgical patients who underwent bi-lobectomy, segmentectomy, pneumonectomy and cavernostomy for pleuropulmonary aspergilloma five postoperative deaths occurred in symptomatic patients but no major postoperative complications were found in the asymptomatic group. 95 While satisfactory surgical outcome in CNPA has been reported after short-term follow-up, 5 the significant negative long-term impact of surgery in predamaged parenchyma needs to be considered as well.…”

Section: Watch and Waitmentioning

confidence: 98%

“…Spillage of Aspergillus to the pleural space complicating surgical procedures has been reported to occur frequently rendering perioperative antifungal treatment mandatory . Removal of a simple aspergilloma by interventional bronchoscopy without surgery had favourable outcome in an elderly patient unfit for surgery . In a retrospective series of 89 surgical patients who underwent bi‐lobectomy, segmentectomy, pneumonectomy and cavernostomy for pleuropulmonary aspergilloma five postoperative deaths occurred in symptomatic patients but no major postoperative complications were found in the asymptomatic group …”

Section: Treatment Options and Prognosismentioning

confidence: 99%

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Chronic pulmonary aspergillosis

Schweer,

Bangard,

Hekmat

et al. 2013

Mycoses

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Summary Chronic pulmonary aspergillosis (CPA) is a group of consuming diseases usually presenting with prolonged and relapsing cough, dyspnoea and weight loss. Acute symptoms such as haemoptysis and bronchial or pulmonary haemorrhage may occasionally occur. CPA affects patients with underlying pulmonary conditions, for example, chronic obstructive pulmonary disease or mycobacteriosis or common immunosuppressive conditions such as diabetes. Precise epidemiology is unknown, and while prevalence is considered low the chronic and relapsing nature of the disease challenges the treating physician. Diagnostics largely rely on serologic Aspergillus precipitins and findings on thoracic computed tomography. The latter are manifold comprising cavity formation, pleural involvement and sometimes aspergilloma. Other markers for aspergillosis are less helpful, in part due to the non‐ or semi‐invasive nature of these forms of Aspergillus infection. Various antifungals were shown to be effective in CPA treatment. Azoles are the most frequently applied antifungals in the outpatient setting, but are now compromised by findings of Aspergillus resistance. Long‐term prognosis is not fully elucidated and may be driven by the underlying morbidities. Prospective registry‐type studies may be suitable to systematically broaden our CPA knowledge base. This article gives an overview of the available literature and proposes a clinical working algorithm for CPA management.

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Section: Watch and Waitmentioning

confidence: 98%

Section: Treatment Options and Prognosismentioning

confidence: 99%

Chronic pulmonary aspergillosis

Schweer,

Bangard,

Hekmat

et al. 2013

Mycoses

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“…Malnourished patients should have supplemental feeding to improve nutritional status before surgery, including the use of nasogastric or percutaneous endoscopic gastrostomy feeding if oral supplementation is inadequate. In patients not deemed candidates for surgery because of a high risk profile, bronchoscopic removal of the aspergilloma should be considered (SoR B and QoE III) [136,137].…”

Section: Follow-upmentioning

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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“…The aggressive removal of the obstructive material (localized bronchial aspergillosis) using a fiberoptic bronchoscope was the key to the survival of this patient. Thus far, there is no consensus on the bronchoscopic or laryngoscopic management of allo-HSCT recipients and bronchoscopic removal has only been mentioned in a series of case reports (31,32). The present case suggests that fiberoptic bronchoscopy should be considered as an alternative treatment option in patients with airway aspergillosis.…”

Section: Discussionmentioning

confidence: 99%

Fulminant Laryngeal-tracheobronchial-pulmonary Aspergillosis: A Rare and Fatal Complication in Allogeneic Hematopoietic Stem Cell Transplantation Recipients

Tao¹,

Zhang²,

Xue

et al. 2017

Intern. Med.

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A 23-year-old man who had previously undergone allogeneic hematopoietic stem cell transplantation (allo-HSCT) for severe aplastic anemia was diagnosed with invasive laryngeal-tracheobronchial-pulmonary aspergillosis after presenting with a persistent dry cough at six months post-transplantation based on the findings of laryngoscopy and fiberoptic bronchoscopy. A fiberoptic bronchoscope was used to remove the obstructive material from the patient's airway and posaconazole plus caspofungin were administered to successfully to treat the patient. Our report suggests that laryngoscopy and fiberoptic bronchoscopy should be considered as alternative approaches to the diagnosis and treatment of allo-HSCT recipients with persistent respiratory symptoms when invasive laryngeal aspergillosis and invasive tracheobronchial aspergillosis are suspected.

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Bronchoscopic Removal of a Large Intracavitary Pulmonary Aspergilloma

Cited by 11 publications

References 15 publications

Chronic pulmonary aspergillosis

Chronic pulmonary aspergillosis

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

Fulminant Laryngeal-tracheobronchial-pulmonary Aspergillosis: A Rare and Fatal Complication in Allogeneic Hematopoietic Stem Cell Transplantation Recipients

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