Surgical treatment of pulmonary aspergilloma and Aspergillus empyema

Twenty-four patients, 16 male and 8 female, underwent a total of 35 operations for pulmonary aspergillosis. Intrapulmonary aspergilloma was detected in 19, and Aspergillus empyema was present in 5. The major operative procedures performed were pneumonectomy in 2 patients, lobectomy in 8, segmentectomy in 1, cavernostomy in 4, and open-window thoracostomy in 5. The surgical results in 5 patients 70 years old or older were excellent. Empyema developed postoperatively in 2 patients who had undergone wedge resection of the lung or segmentectomy. Although resection involving the minimum extent possible is desirable in the treatment of intrapulmonary aspergilloma so as not to decrease lung function, it is dangerous to perform a limited procedure in the case of aspergilloma with an invasive character. In patients in poor general condition, cavernostomy followed by muscle flap plombage is recommended. For Aspergillus empyema, the primary procedure was open-window thoracostomy followed by plombage using chest wall muscle or omentum. We consider omental flap plombage to be superior to thoracoplasty in some respects for mycotic empyema, especially because it is a less extensive surgical procedure.