Surgery for pulmonary aspergillosis

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

“…Previous series reported mortality rates of up to 43% and morbidity including hemorrhage, residual pleural space, bronchopleural fistula, and empyema at rates of up to 60%. 5,[11][12][13][14] The fluctuating nature of the disease process and the modest surgical results restricted surgery to patients with significant symptoms. However, recent reports from the early 2000s showed a dramatic reduction in surgical-related mortality and morbidity.…”

“…4 Surgical resection of the localized pulmonary lesion contributes not only to reducing symptoms but also to the likelihood of a permanent cure for aspergilloma. 3,5,6 Although recent advances in thoracic surgery have indicated favorable acute and long-term outcomes [7][8][9][10] compared with early high morbidity and high mortality rates 5,[11][12][13][14] with the management of pulmonary aspergilloma, there is at present no consensus about the role of surgical resection in the treatment of pulmonary aspergilloma.…”

The Clinical Spectrum of Pulmonary Aspergillosis

“…34 The surgical treatment of aspergilloma is associated with relatively high mortality rate that ranges between 7% and 23%. [15][16][17][35][36][37][38] The most common causes of death following surgery are severe underlying lung disease, pneumonia, acute myocardial infarction, and IPA. 19,38 In addition, there is significant postoperative morbidity, including bleeding, residual pleural space, bronchopulmonary fistula, empyema, and respiratory failure.…”

Pulmonary Aspergillosis

“…84 The most frequent symptom of this disease is hemoptysis, which is reported to occur in 50 to 80% of patients with aspergilloma. [85][86][87] Hemoptysis is usually intermittent and mild but occasionally becomes severe and can cause death. The mechanism of bleeding is not known, but it has been attributed to friction of a fungus ball against the hypervascular cavity wall, endotoxin enzymes with hemolytic properties liberated from the fungus, 88 and type III reaction causing inflammatory injury.…”

“…83 Differential diagnosis of similar roentgenographic findings includes mycetoma from other fungus, especially Candida, hydatid cyst, necrotic tumor, blood clot, a cyst, abscess with necrotic debris, or Rasmussen's aneurysm. 86,91,94 The diagnosis of aspergilloma can usually be made on the basis of the characteristic radiographic finding. Repeated positive cultures of A. fumigatus from sputum or bronchial washing specimens or positive skin tests against Aspergillus antigens are supportive of the diagnosis, but demonstration of positive precipitins against Aspergillus antigens is necessary to confirm it.…”