Complex pulmonary aspergilloma treated with single stage cavernostomy and myoplasty

Abstract

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.

Pulmonary Aspergilloma Treated by Limited Thoracoplasty with Simultaneous Cavernostomy and Muscle Transposition Flap

“…Although lung resection is the optimal curative treatment for pulmonary aspergilloma, several authors have reported that single-stage cavernostomy and myoplasty is an effective alternative therapy for this condition, since Daly et al reported its use for the first time. [2][3][4] One reported cause of failure in this treatment is muscle flap disuse atrophy. 3) In our patient, the following were considered important for obtaining a successful result: 1.…”

“…1) Therefore, successful results of single-stage cavernostomy and myoplasty as palliative therapy for these high-risk patients have been reported by several authors. [2][3][4] In this form of treatment, muscle flap disuse atrophy is sometimes a cause of failure. Here, we report a case of pulmonary aspergilloma that was treated successfully by limited thoracoplasty with simultaneous single-stage cavernostomy and a muscle transposition flap, and review the relevant literature.…”

Tratamento cirúrgico de aspergiloma pulmonar

“…(3,5,9,(10)(11)(12) Surgical mortality and morbidity are related to the type of pulmonary aspergilloma. (2,3) Because individuals with CPA more often have postoperative complications, such as prolonged air leak, empyema, and bleeding, mortality is higher in CPA than in SPA. (3,5,9,10) Because of the impaired immunity of patients undergoing chemotherapy, patients on corticosteroid therapy, diabetic patients, AIDS patients, and transplant recipients, as well as the high mortality associated with pulmonary mycoses, clinicians and surgeons should focus on the diagnosis and management of complications in pulmonary aspergilloma and in other pulmonary mycoses.…”

Lung resection and application of latissimus dorsi muscle flap for pulmonary aspergilloma: Case report

“…Kronik malnutrisyon, kronik obstruktif akciğer hastalığı ve parankimal akciğer hastalığı da risk faktörlerindendir [2]. Tü-berküloz, sıkı plevral adhezyonlar ve hasta akciğer parankimi aspergillomada standart akciğer rezeksiyonu sonrası mortalite oranını arttıran faktörlerdir [6]. Postoperatif morbidite aşırı kanama, uzamış hava kaçağı, rezidüel plevral boşluk, bronkoplevral fistül ve ampiyemi içerir [6].…”

“…Tü-berküloz, sıkı plevral adhezyonlar ve hasta akciğer parankimi aspergillomada standart akciğer rezeksiyonu sonrası mortalite oranını arttıran faktörlerdir [6]. Postoperatif morbidite aşırı kanama, uzamış hava kaçağı, rezidüel plevral boşluk, bronkoplevral fistül ve ampiyemi içerir [6]. Ciddi plevral boşluk enfeksiyonunun tedavisinde ve bronkoplevral fistül tamiri için ekstratorasik kas flebi kullanılabilir [2].…”