Pulmonary aspergilloma: Analysis of prognosis in relation to symptoms and treatment

Lee, Jin Gu; Lee, Chang Young; Park, In Kyu; Kim, Dae Joon; Chang, Joon; Kim, Se Kyu; Chung, Kwansoo

doi:10.1016/j.jtcvs.2009.01.019

Cited by 70 publications

(83 citation statements)

References 26 publications

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“…5 Of these, tuberculosis is probably the most common association especially in developing countries. 6 The symptoms and signs of CPA can range from incidentally detected chest radiographic findings to a situation with life-threatening haemoptysis.…”

Section: Introductionmentioning

confidence: 99%

Itraconazole in chronic cavitary pulmonary aspergillosis: a randomised controlled trial and systematic review of literature

Agarwal

Gella

Aggarwal

et al. 2013

Mycoses

116

133

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SummaryPatients with aspergilloma can be safely managed with supportive therapy in absence of massive haemoptysis. We hypothesised that chronic cavitary pulmonary aspergillosis (CCPA) could also be managed on similar grounds. The aim of this prospective, randomised controlled trial was to evaluate the efficacy and safety of itraconazole in CCPA. Consecutive patients of CCPA with presence of chronic pulmonary/ systemic symptoms; and pulmonary cavities; and presence of Aspergillus (immunological or microbiological) were randomised to receive either supportive treatment alone or itraconazole 400 mg daily for 6 months plus supportive therapy. Response was assessed clinically, radiologically and overall after 6 months therapy. A total of 31 patients (mean age, 37 years) were randomised to itraconazole (n = 17) or the control (n = 14) group. The number of patients showing overall response was significantly higher in the itraconazole group (76.5%) vs. the control (35.7%) group (P = 0.02). The numbers of patients demonstrating clinical or radiological response were also significantly higher in the itraconazole group (P = 0.016 and 0.01 respectively). Adverse events were noted in eight patients in the itraconazole group, however, none was serious or led to discontinuation of the study drug. Itraconazole was found to be superior to standard supportive treatment alone in stabilising cases of CCPA. (clinicaltrials.gov; NCT01259336).

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Section: Introductionmentioning

confidence: 99%

Itraconazole in chronic cavitary pulmonary aspergillosis: a randomised controlled trial and systematic review of literature

Agarwal

Gella

Aggarwal

et al. 2013

Mycoses

116

133

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“…The Aspergillus fumigatus is the causative agent in over 90% of cases. The fungal spores,though of low virulence, may form the aspergilloma, especially in immunocompetent hosts [1][2][3][4][5][6] .…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Complex pulmonary aspergilloma treated by cavernostomy

Silva

Marsico

Araujo

et al. 2014

Rev. Col. Bras. Cir.

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Results Results: Ten patients were male. The mean age was 42.9 years (34-56). The most frequent symptom was repeated pulmonary bleeding. Cavernostomy was proposed for patients at high risk for lung resection. It was performed in 17 patients and all of them had pulmonary tuberculosis sequelae, with cavitations. The indication in all cases was hemoptysis and elimination of phlegm. The cavernostomies were performed in a single surgical procedure. In all 17 patients the cavity was left open after the withdrawal of the mycetoma. In all patients hemoptysis ceased immediately. Operative mortality was 9.5% (1). Conclusion Conclusion Conclusion Conclusion Conclusion: cavernostomy is an effective treatment alternative in patients at high risk. It may be useful in some patients with complex aspergilloma, irrespective of lung function or bilateral disease. It is technically easy, has low-risk, saves parenchyma, and may be performed in a single operative time.

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“…To the best of our knowledge, there is no consistent evidence that aspergilloma responds to systemic administration of antifungal agents (12). In certain reports, surgical treatment was a good alternative (16)(17)(18), but the pulmonary function and tolerance of patients should be considered. It is suggested that Table II.…”

Section: Discussionmentioning

confidence: 99%

“…1). 18 F-deoxyglucose (FDG) dual-head coincidence single-photon emission computerized tomography (DHTC) indicated that the maximum tumor to non-tumor ratio was 11.63 and therefore, the possibility of lung cancer was not eliminated (Fig. 2).…”

Section: Representative Casementioning

confidence: 99%

Endobronchial aspergilloma: A case report and literature review

Huang

Chu

et al. 2016

1.13 Clinical Problems - Other

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Abstract. The present study aimed to investigate the clinical and radiological characteristics in addition to the bronchoscopic appearance in patients with endobronchial aspergilloma (EBA). Clinical and radiological characteristics were analyzed alongside the bronchoscopic appearance in 17 patients with EBA diagnosed by bronchoscopy with histological examination. The present study assessed the relevant literature and 13 males and 4 females were included in the comparison, with a median age of 59. Associated diseases included 8 previous diagnoses of pulmonary tuberculosis (47.6%), 4 previous diagnoses lung cancer (23.5%), 1 pulmonary resection (5.9%) and 1 bronchial foreign body (5.9%). The primary symptom was hemoptysis (9/17, 53%). Chest computed tomography (CT) indicated a markedly higher incidence of aspergillosis lesion in the left lung (13/17; 76.5%) compared with the right lung (4/17; 23.5%). CT manifestation included space occupying disease in 10 patients (58.8%), aspergilloma in 3 patients (17.6%), pneumonic consolidation in 2 patients (11.8%) and ground glass opacity in 1 patient (5.9%). Bronchoscopy examination identified masses in all 17 patients' bronchial lumen and 15 patients had endobronchial obstruction by necrotic material. The case presented in the current study demonstrated the merits of combining bronchosopic intervention with voriconazole. The dominant symptom of EBA was hemoptysis. Chest CT demonstrated that aspergillosis lesions were more frequently identified in the left lung compared with the right. EBA often occurs in individuals with underlying lung diseases, which cause lumen structural change or bronchial obstruction. EBA may be clearly diagnosed by bronchoscopy biopsy, although the potential for a co-exististing tumor requires consideration. Bronchoscopic intervention and anti-fungal therapy may have an advantage in the effective treatment of patients with EBA. IntroductionAspergillus spp. are a ubiquitous fungus in the environment, which are easily identified in soil, water and various types of decomposing organic matter (1). Inhalation of Aspergillus spores causes pulmonary aspergillosis, which is the most common form of aspergillus filamentous fungal infection, and is often diagnosed in patients with immune deficiencies or systemic diseases (2). Aspergillosis is currently divided into the following categories (3): i) Invasive pulmonary aspergillosis (IPA), a severe disease and major cause of mortality in severely immunocompromised patients; ii) chronic necrotizing aspergillosis (CNA), presents as a locally invasive disease and is observed primarily in patients who are mildly immunocompromised or have chronic lung disease; and iii) allergic bronchopulmonary aspergillosis (ABPA), a non-invasive hypersensitivity pulmonary disease caused by Aspergillus. Aspergilloma is a fungus ball that develops in a pre-existing cavity in lung parenchyma, which may be easily detected by X-ray and computed tomography (CT) scans (3). In addition, a novel category of aspergillosis with semi-invasive f...

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Pulmonary aspergilloma: Analysis of prognosis in relation to symptoms and treatment

Cited by 70 publications

References 26 publications

Itraconazole in chronic cavitary pulmonary aspergillosis: a randomised controlled trial and systematic review of literature

Itraconazole in chronic cavitary pulmonary aspergillosis: a randomised controlled trial and systematic review of literature

Complex pulmonary aspergilloma treated by cavernostomy

Endobronchial aspergilloma: A case report and literature review

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