Inoperable pulmonary aspergilloma: percutaneous CT-guided injection with glycerin and amphotericin B paste in 15 cases.

Giron, J.; C, Poey; Fajadet, P; Balagner, G B; Assoun, J; Richardi, G; Haddad, José; Caceres, J C; Sénac, J. P.; Railhac, J.J.

doi:10.1148/radiology.188.3.8351356

Cited by 42 publications

(23 citation statements)

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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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Section: Pulmonary Collectionsmentioning

confidence: 99%

Imaging guided thoracic interventions

Ghaye¹,

Dondelinger²

2001

Eur Respir J

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“…The CT-guided injected paste also provided prolonged exposure to the antifungal agent, and led to the disappearance of the aspergilloma and a negative result for Aspergillus spp. serology [71]. This procedure is, however, problematic for those with compromised pulmonary function and can be associated with pulmonary abscess, anaphylactic shock, pneumothorax, haemoptysis and pleural seeding.…”

Section: Cpa: Current Treatment Optionsmentioning

confidence: 99%

Chronic Pulmonary Aspergillosis: An Update on Diagnosis and Treatment

Godet¹,

Philippe

Laurent

et al. 2014

Respiration

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Chronic pulmonary aspergillosis (CPA) affects individuals with non-systemic or mildly systemic immunodepression or altered pulmonary integrity due to underlying disease. It has been reported with a variety of clinical and radiological patterns. The condition should be distinguished from simple aspergilloma and allergic bronchopulmonary aspergillosis as well as invasive aspergillosis in severely immunocompromised patients. CPA generally requires long-term antifungal treatment and surgery may be considered. Life-threatening haemoptysis may be prevented by bronchial arteriography with embolisation. However, currently there are no documented treatment recommendations for CPA. This review provides an up-to-date practical overview of this condition, including a comprehensive update on diagnosis and management.

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“…Percutaneous therapy has generally been considered to be a last resort, only attempted when surgical options are either contraindicated or refused by the patient [87]. It has only been described in the published literature for use in the treatment of pulmonary aspergilloma, often associated with haemoptysis [87][88][89][90][91][92][93][94][95][96][97][98][99]. Patients usually had some form of underlying pulmonary disease that would facilitate the development of Aspergillus infection, such as prior pulmonary tuberculosis [88][89][90]95,96], sarcoidosis [88,[97][98][99], bullous lung disease [98], bronchiectasis [99], chronic obstructive pulmonary disease (COPD) [99], pulmonary fibrosis [88], previous radiation therapy [89] and asthma [91].…”

Section: Percutaneous Deliverymentioning

confidence: 99%

“…Treatment of aspergilloma utilising pastes containing either amphotericin B or nystatin have been described [88,92]. The potential advantage of the paste is that it would solidify at body temperature, remaining in the cavity for extended periods of time and potentially lengthen the time between treatments [92].…”

Section: Percutaneous Pastesmentioning

confidence: 99%

“…A total of 5 ml (25 mg of amphotericin B and 225,000 units of nystatin) were injected at one time into patients, usually every 5 -7 days. The second published report of percutaneous pastes only utilised amphotericin B [88]. The paste was prepared in a similar method to the first report, with the only differences being that glycerin was utilised as a base instead of lipophilic gel vehicle, 10 ml were injected at a time instead of 5 ml, and injections were given every 1 -3 weeks.…”

Section: Percutaneous Pastesmentioning

confidence: 99%

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Novel modes of antifungal drug administration

Arthur¹,

Drew²,

Perfect³

2004

Expert Opinion on Investigational Drugs

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Administration of antifungals by routes other than that for which the agent was designed or approved have been utilised in attempts to provide directed therapy, reduce adverse effects and improve drug penetration into selected infection sites, such as the central nervous system, lungs and peritoneum. The most widely investigated agent utilising a novel method of drug delivery is amphotericin B. Dose forms for this agent include topicals (aerosol, nasal spray, irrigations, pastes, absorbable sponges, impregnated bone cement and gelatin), oral dosage forms (solutions, suspensions, tablets and so on) and ophthalmic preparations (drops, ointments and injections). Amphotericin B has been administered by routes such as oral, endobronchial, intrathecal, intracisternal, intra-articular, intraperitoneal, ophthalmic and as an antibiotic 'line lock'. Nystatin has been administered as an aerosol, percutaneous paste and bladder washes. Azoles, such as miconazole, fluconazole, ketoconazole and posaconazole, have been administered by novel methods but to a lesser degree. Most of these reports involve miconazole. The dose forms and routes of administration for azoles have included irrigants (bladder, joint), ophthalmic preparations (eye drops, intraocular injections, ointments), impregnated bone cement, endobronchial and intrathecal administration. Finally, both methylene blue (bladder washes) and flucytosine (peritoneal lavage, ophthalmic eye drops) have also been employed. Adequate evaluations of both the safety and efficacy of these therapies are most often hindered by prior or concomitant antifungal therapies, comorbidities and the lack of controlled clinical trials. In addition, the availability of newer treatment options, which demonstrate significant improvement in drug distribution and treatment-related adverse effects make many such novel modes of administration less practical or necessary. In contrast, the inhalation of antifungal aerosols, such as amphotericin B, is rapidly becoming a viable prophylactic option.

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Inoperable pulmonary aspergilloma: percutaneous CT-guided injection with glycerin and amphotericin B paste in 15 cases.

Cited by 42 publications

References 0 publications

Imaging guided thoracic interventions

Imaging guided thoracic interventions

Chronic Pulmonary Aspergillosis: An Update on Diagnosis and Treatment

Novel modes of antifungal drug administration

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