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Bronchial stump aspergillosis
J P Le Rochais1, P Icard, T Simon
1Service de Chirurgie Thoracique et Cardiovasculaire, CHU Côte de Nacre, Caen, France.
Abstract:
Two cases of bronchial stump aspergillosis were diagnosed 5 and 6 years after pneumonectomy for lung cancer. In each case, the fungal mass was endoscopically removed using standard forceps. A recurrence of the fungal mass persisted until all visible protruding nylon threads in the airway lumen were destroyed with a Nd:YAG laser. Removal of the visible suture is necessary for eliminating the infection. No additional local or systemic antifungal therapy is needed.
Insights
Bronchial stump aspergillosis after lung cancer surgery can recur due to suture material. Complete removal of visible nylon threads with a Nd:YAG laser is crucial for resolving this fungal infection.
Area of Science:
- Medical Mycology
- Thoracic Surgery
- Pulmonology
Background:
- Bronchial stump aspergillosis is a rare complication following pneumonectomy.
- Persistent fungal infections can arise from residual foreign material in the airway.
Observation:
- Two patients developed bronchial stump aspergillosis 5 and 6 years post-pneumonectomy for lung cancer.
- Initial endoscopic removal of fungal masses with forceps was insufficient to prevent recurrence.
Findings:
- Recurrent fungal masses resolved only after visible protruding nylon suture threads were destroyed using a Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser.
- Complete elimination of the foreign material (suture) was key to resolving the infection.
Implications:
- Visible suture material in the airway lumen can serve as a nidus for persistent fungal infections like aspergillosis.
- Endoscopic laser ablation of foreign bodies may be a necessary adjunct to surgical management of bronchial stump aspergillosis.
- Antifungal therapy may not be required if the underlying foreign material is successfully removed.