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Aspergilloma and the surgeon
Loven Moodley1, Jehron Pillay1, Keertan Dheda1
11 Chris Barnard Division of Cardiothoracic Surgery, 2 Division of Pulmonology, Groote Schuur Hospital, University of Cape Town, South Africa.
Abstract:
Aspergillus fungus is a ubiquitous saprophyte that is the causative organism for the development of an aspergilloma. The most common species causing an aspergilloma is the Apergillus fumigatus. An aspergilloma is a conglomeration of mucus, inflammatory cells and altered blood elements. Aspergillomas typically form in pre-existing lung pathology, most notably and commonly in old healed tuberculosis cavities. They are classified into simple and complex types that have clinical relevance. Symptoms are very variable and it is not uncommon to incidentally find a lung aspergilloma. In most case series, the most common presenting symptom is haemoptysis which varies from mild to catastrophic bleeds. Given the limited information about the natural history of the disease, there is unfortunately no recognised factor or variable which can predict how an aspergilloma will manifest itself, hence the manner of treatment is a still a topic of debate among treating physicians. The mainstay of treatment is surgical intervention and medical options although disappointing at the current stage, require further investigation in light of the newer available anti-fungal agents. The need for surgical intervention is however not as clear-cut as one would like, since many patients have multiple co-morbidities and other diffuse or focal lung pathology, making the decision process indeterminate in certain instances. In this review, we focus on the different surgical options available for the management of aspergilloma across variable clinical settings, and we propose an approach to its management.
Insights
Aspergilloma, often caused by Aspergillus fumigatus, forms in pre-existing lung conditions like tuberculosis cavities. This review explores surgical management options for lung aspergilloma, addressing treatment debates and clinical decision-making.
Area of Science:
- Medical Mycology
- Pulmonology
- Surgical Pathology
Background:
- Aspergilloma is a fungal ball, typically Aspergillus fumigatus, developing in pre-existing lung cavities, commonly from tuberculosis.
- It presents with variable symptoms, most frequently haemoptysis, ranging from mild to severe.
- The natural history and predictive factors for aspergilloma manifestation remain poorly understood, leading to treatment debates.
Purpose of the Study:
- To review available surgical interventions for managing pulmonary aspergilloma.
- To propose a management approach considering diverse clinical scenarios and patient comorbidities.
- To highlight the ongoing debate regarding the optimal treatment strategy for aspergilloma.
Main Methods:
- Review of existing literature on aspergilloma management.
- Analysis of different surgical techniques and their applicability.
- Discussion of medical treatment options and newer antifungal agents.
Main Results:
- Aspergillomas are classified into simple and complex types with clinical significance.
- Surgical intervention is the primary treatment, but its necessity is debated due to patient comorbidities.
- Medical management with antifungal agents is currently limited but warrants further investigation.
Conclusions:
- The decision for surgical intervention in aspergilloma management is complex, influenced by patient factors and lung pathology.
- Further research into medical treatments and a standardized approach to surgical management are needed.
- This review provides insights into surgical options and proposes a framework for clinical decision-making in aspergilloma cases.
