Surgical Management of Pulmonary Cavity Associated with Fungus Ball

Abstract

Surgery for pulmonary cavity associated with fungus ball is challenged by chronic lung disease. The purpose of this report was to review patient data, operative procedures and results of surgery. This was a retrospective study. Twenty patients were operated on between January 1997 and December 2002. Fourteen (70%) patients were male and the mean age was 46.30 +/- 13.10 years (range, 24 to 76 years). The most common underlying pulmonary disorder was tuberculosis (70%). Ninety five percent of the patients had a history of hemoptysis, and 35% presented with massive hemoptysis. Lobectomy was performed in 11 (55%) patients and 6 (30%) patients were operated on by cavernostomy with transposition of muscle flap technique. There was no operative mortality and 8 complications (3 prolonged airleaks, 2 wound infections, 1 postoperative bleeding, 1 seroma and 1 empyema). It was also found that emergency surgery and cavernostomy with transposition of muscle flap compromised the postoperative course. Surgery is very effective in controlling and preventing hemoptysis in patients who have pulmonary cavity associated with fungus ball. Elective surgery and formal pulmonary resection may be the proper option for low risk patients. Cavernostomy with transposition of muscle flap may be suitable for patients who have poor pulmonary reserve.

Surgical treatment of pulmonary aspergillosis: A single center experience

“…reported a history of tuberculosis ranging from 2 to 20 years (average 8.2 years) in their patients of aspergilloma. [ 6 ] In our series, the duration from active tuberculosis to aspergilloma was from 2 to 5 years (mean 3.4 years).…”

Lung resection in pulmonary aspergilloma: experience of a Moroccan center

“…This is why the surgical decision of pleuro-pneumonectomy should be well evaluated preoperatively taking in mind that cavernostomy is still a surgical option and a viable alternative, even to those that can be submitted to pulmonary resection, especially in patients with pneumonectomy indication and also in those with bilateral aspergilloma. The cavernostomy is necessary in patients with compromised lung function, with lower morbidity, mortality and functional deficit [ 11 , 23 , 24 , 26 , 27 ].…”

Complex pulmonary aspergilloma treated by cavernostomy

“…The cavernostomy is defined as necessary in patients with temporarily or permanently compromised lung function, with lower morbidity, mortality and functional deficit. It is considered a viable alternative, even to those that can be submitted to pulmonary resection 3,10,13,15,[22][23][24][25] . The surgical decision in our 17 patients would be between pneumonectomy and cavernostomy.…”

“…In some cases, computed tomography is fundamental to locate the fungal ball and to the definition of the incision to access it. Operative techniques differ after the opening of the cavity and the removal of fungal ball 1,3,13,18,24 . Regnard et al performed 17 cavernostomies without registering deaths or major complications 7 .…”

“…Rergkliang et al performed six cavernostomies with muscle transposition in a single operative time 3 . They believe that the results and survival with cavernostomy are comparable to pulmonary resection, and recommend that, due to the ease of cavernostomy with muscle transposition, it should be performed in patients with impaired respiratory function, those with large pleural adhesions and in emergency situations where the study of lung function is not possible.…”