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A Series of Transbronchial Removal of Intracavitary Pulmonary Aspergilloma
David R Stather1, Alain Tremblay1, Elaine Dumoulin1
1Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Background:
Intracavitary pulmonary aspergilloma is a chronic, debilitating fungal infection. Without definitive therapy, death can occur from massive hemoptysis, cachexia, or secondary infection. Although surgical resection is the standard therapy, it is not possible for many patients owing to poor pulmonary function or medical comorbidities. Aspergilloma removal through bronchoscopy is an important alternative therapy that may be available in select cases.
Methods:
We retrospectively reviewed all cases referred to the University of Calgary Interventional Pulmonary Service for transbronchial removal of intracavitary aspergilloma from January 1, 2009, to January 1, 2014.
Results:
Ten patients with intracavitary pulmonary aspergilloma were identified. In 3 patients, the aspergilloma cavity was not accessible by bronchoscopy. Successful removal of the aspergilloma with symptom improvement or resolution was achieved in 6 of 7 cases. One of the patients was lost to follow-up. Minor hypoxia lasting 12 to 72 hours was observed in 5 cases. Severe sepsis requiring an extended critical care unit stay occurred in 1 case. Follow-up ranged from 9 months to 5 years.
Conclusions:
Although not without risk of minor hypoxia and possible sepsis, for carefully selected patients, bronchoscopic removal of symptomatic intracavitary pulmonary aspergilloma may be an alternative therapy to surgical resection for this life-threatening disease.
Insights
Bronchoscopic removal of pulmonary aspergilloma offers an alternative to surgery for select patients. This minimally invasive procedure successfully treated most cases, though risks like hypoxia and sepsis were noted.
Area of Science:
- Pulmonology
- Interventional Pulmonology
- Mycology
Background:
- Intracavitary pulmonary aspergilloma is a serious fungal infection with high mortality without treatment.
- Surgical resection, the standard therapy, is often not feasible due to patient comorbidities.
- Bronchoscopic removal presents a viable alternative for eligible patients.
Purpose of the Study:
- To evaluate the efficacy and safety of transbronchial aspergilloma removal.
- To assess bronchoscopy as an alternative to surgery for pulmonary aspergilloma.
Main Methods:
- Retrospective review of patients undergoing transbronchial aspergilloma removal.
- Study period: January 2009 to January 2014 at the University of Calgary.
- Inclusion criteria: Patients referred for interventional pulmonary service for aspergilloma removal.
Main Results:
- Seven out of ten patients with intracavitary pulmonary aspergilloma underwent successful bronchoscopic removal.
- Symptom improvement or resolution was observed in 6 of the 7 successfully treated cases.
- Complications included transient hypoxia in 5 cases and severe sepsis in 1 case.
Conclusions:
- Bronchoscopic removal is a potentially life-saving alternative to surgery for carefully selected patients with pulmonary aspergilloma.
- While risks such as hypoxia and sepsis exist, they are manageable in a select patient group.
- This interventional approach offers hope for patients unable to undergo surgical resection.
