CT-guided percutaneous treatment of inoperable pulmonary aspergillomas: a study of 40 cases

Giron, J.; C, Poey; Fajadet, P; Sans, N.; Fourcade, D; Sénac, J. P.; Railhac, J.J.

doi:10.1016/s0720-048x(97)00148-4

Cited by 82 publications

(34 citation statements)

References 8 publications

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“…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.…”

Section: Duration Of Antifungal Therapy For Cpamentioning

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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Section: Duration Of Antifungal Therapy For Cpamentioning

confidence: 99%

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

Denning¹,

Cadranel²,

et al. 2015

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“…Life-threatening haemoptysis due to intracavitary aspergilloma may be recurrent, despite an initially successful bronchial embolization, and eventually require surgical resection [114±120]. Open thoracotomy however, can be contraindicated in some patients who present with a severe underlying pulmonary condition [118,120]. Transthoracic instillation of amphothericin B has been described with a success rate of 50% for resolution of the aspergilloma and 75±100% for acute control of haemoptysis [117±121].…”

Section: Pulmonary Collectionsmentioning

confidence: 99%

Imaging guided thoracic interventions

Ghaye¹,

Dondelinger²

2001

Eur Respir J

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Interventional Radiology is a technique based medical specialty, using all available imaging modalities (¯uoroscopy, ultrasound, computed tomography, magnetic resonance, angiography) for guidance of interventional techniques for diagnostic or therapeutic purposes.Actual, percutaneous transthoracic needle biopsy includes core needle biopsy besides ®ne needle aspiration. Any pleural, pulmonary or mediastinal¯uid or gas collection is amenable to percutaneous pulmonary catheter drainage.Treatment of haemoptysis of the bronchial artery or pulmonary artery origin, transcatheter embolization of pulmonary arteriovenous malformations and pseudoaneurysms, angioplasty and stenting of the superior vena caval system and percutaneous foreign body retrieval are well established routine procedures, precluding unnecessary surgery. These techniques are safe and effective in experienced hands.Computed tomography is helpful in pre-and postoperative imaging of patients being considered for endobronchial stenting. Many procedures can be performed on an outpatient basis, thus increasing the cost-effectiveness of radiologically guided interventions in the thorax.

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“…Surgical management is required to avoid or treat fatal hemoptysis from vascular erosion. However, lung resection is generally contraindicated in these patients with poor lung function and in those with bilateral disease [7][8][9][10]. Cavernostomy and single stage myoplasty has been advocated and used by Daly et al [1], as a secondary method for the treatment of post-operative complications in three patients.…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous instillation of Amphotericin-B has also been tried to treat aspergilloma and to control massive bleeding in patients with compromised lung function or bilateral disease. Giron et al [9], treated 40 patients with Amphotericin-B paste and achieved the cessation of bleeding in all cases and negative aspergillus serum tests in 26 cases (follow-up time 6-28 months) Rumbak et al [10], have also used potassium iodide in patients with FEV1!50% and massive hemoptysis. They achieved cessation of bleeding in 72 h in all patients.…”

Section: Discussionmentioning

confidence: 99%

Complex pulmonary aspergilloma treated with single stage cavernostomy and myoplasty

Gebitekin

Bayram

Akın

2005

European Journal of Cardio-Thoracic Surgery

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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.

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CT-guided percutaneous treatment of inoperable pulmonary aspergillomas: a study of 40 cases

Cited by 82 publications

References 8 publications

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

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

Imaging guided thoracic interventions

Complex pulmonary aspergilloma treated with single stage cavernostomy and myoplasty

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