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[Pulmonary aspergilloma]
T Etienne1, A Spiliopoulos, R Mégevand
1Clinique de chirurgie thoracique, Hôpital cantonal universitaire, Genève.
Abstract:
Pulmonary aspergillomas usually arise from colonization of Aspergillus in preexisting lung cavities. Between 1972 and 1988, 18 patients underwent thoracotomy for treatment of pulmonary aspergilloma in our institution. Eight patients had simple aspergilloma and ten had complex aspergilloma. Hemoptysis was the most frequent complication. Tuberculosis was the most common underlying lung disease. Patients presenting with complex aspergilloma usually had associated factors potentially reducing their immune competence. Patients with simple aspergilloma tolerated surgery quite well and the outcome was satisfactory. By contrast operative mortality was 30% (3 deaths) in patients with complex aspergilloma and complications occurred in 8 patients (80%). Treatment of pulmonary aspergilloma must be individualized to take into account the patient's overall health and the risks attendant with each treatment modality.
Insights
Pulmonary aspergilloma treatment requires individualization. Complex cases have higher risks and mortality, unlike simple aspergillomas, necessitating tailored surgical approaches.
Area of Science:
- Pulmonology
- Infectious Diseases
- Thoracic Surgery
Context:
- Pulmonary aspergillomas often result from Aspergillus colonization in pre-existing lung cavities.
- This study reviews 18 cases of pulmonary aspergilloma treated with thoracotomy between 1972 and 1988.
- Underlying lung diseases, particularly tuberculosis, are common precursors.
Purpose:
- To evaluate the outcomes and complications of surgical treatment for pulmonary aspergilloma.
- To differentiate between simple and complex aspergillomas and their respective surgical prognoses.
- To emphasize the need for individualized treatment strategies based on patient health and disease complexity.
Summary:
- Eight patients had simple aspergillomas, with satisfactory surgical outcomes.
- Ten patients had complex aspergillomas, experiencing a 30% operative mortality and 80% complication rate.
- Hemoptysis was the most frequent complication, and reduced immune competence was noted in complex cases.
Impact:
- Surgical outcomes for simple pulmonary aspergillomas are generally favorable.
- Complex pulmonary aspergillomas present significant surgical risks, including high mortality and morbidity.
- Individualized treatment plans are crucial for managing pulmonary aspergilloma effectively, considering patient-specific factors and treatment modality risks.