Severe Hemoptysis Associated with Pulmonary Aspergilloma

Shapiro, Mia; Albelda, Steven Μ.; Mayock, Robert L.; McLean, Gordon K.

doi:10.1378/chest.94.6.1225

Cited by 84 publications

(39 citation statements)

References 21 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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“…Helical CTscan quickly provides precise, anatomical localization of the cavity as well as demonstrating intracavity masses likely to represent a fungus ball. Therefore this method prevents complications, such as pneumothorax, bleeding, and subcutaneous emphysema (10).…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Fungus Ball in a Patient with Allergic Bronchopulmonary Aspergillosis: Continuous Percutaneous Instillation of Antifungal Agents into the Cavity.

1996

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A 53-year-old male of allergic bronchopulmonary aspergillosis (ABPA) with pulmonary fungus ball, who had been administered steroid and suffered repeatedly from dyspnea, was treated successfully with continuous percutaneous instillation of antifungal agents into the cavity. Although the pulmonary fungus ball in his left upper lobe was thought to be worsening ABPA,oral and intravenous antifungal agents failed to improve the clinical course. Weselected to use continuous instillation of antifungal agents via an indwelling catheter which was inserted percutaneously into the cavity. Although the instillation offluconazole (FCZ) for four weeks did not alter the process, two-week instillation of amphotericin B (AMPH)caused disappearance of the fungus ball. Wemeasured the plasma concentration of FCZ and AMPH during their instillation into the cavity to ascertain this treatment to be free from side effects pharmacokinetically. (Internal Medicine 35: 736-741, 1996)

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“…There have been several reports describing the use of intracavitary therapy to treat aspergilloma (2)(3)(4)(5). Intracavitary therapy offers a numberof advantages: no loss of lung function, ease and rapidity of catheter insertion, prompt response to treatment, relatively short hospitalization, and the possibility to repeat the procedure in the sameor another cavity if necessary (3).…”

Section: Introductionmentioning

confidence: 99%

“…Intracavitary therapy offers a numberof advantages: no loss of lung function, ease and rapidity of catheter insertion, prompt response to treatment, relatively short hospitalization, and the possibility to repeat the procedure in the sameor another cavity if necessary (3). Bleeding and pneumothorax have been seen in association with needling the cavities or with placement of a stiff guidewire (2)(3)(4). Cough, sputum production and bronchospasmare complications of the injection of antifungals and contrast agents (3,4).…”

Section: Introductionmentioning

confidence: 99%

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Empyema Following the Percutaneous Instillation of Antifungal Agents in Patients with Aspergillosis.

et al. 1996

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Wereport two cases of empyema as a complication of the percutaneous instillation of antifungal drugs for pulmonary and pleural aspergillosis.Case 1 underwent percutaneous administration of amphotericin B and fluconazole for 2 months. Six months later, the patient was found to have an Aspergillus empyemawith a bronchopleural fistula. Case 2 with pulmonary and pleural aspergillosis underwent percutaneous administration of amphotericin B for one month. Four months later, the patient underwent pleural drainage due to empyema. Pleural biopsy revealed pleural aspergillosis. In both cases, it was suggested that the preceding Aspergillus infection and percutaneous instillation of antifungals resulted in the development of empyema. (Internal Medicine 35: 657-659, 1996)

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Severe Hemoptysis Associated with Pulmonary Aspergilloma

Cited by 84 publications

References 21 publications

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

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

Successful Treatment of Fungus Ball in a Patient with Allergic Bronchopulmonary Aspergillosis: Continuous Percutaneous Instillation of Antifungal Agents into the Cavity.

Empyema Following the Percutaneous Instillation of Antifungal Agents in Patients with Aspergillosis.

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