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Surgery for pulmonary aspergilloma and pleural aspergillosis
1Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik Essen-Heidhausen, FRG.
Abstract:
Pulmonary aspergilloma and pleural aspergillosis are a potentially lifethreatening disease resulting from the colonization of lung or pleural cavities by the ubiquitous fungus Aspergillus fumigatus. Twenty four patients with pulmonary aspergilloma and five with pleural aspergillosis underwent major thoracic procedures at our hospital between 1976 and 1986. Fourteen of the patients had haemoptysis, in 9 it was recurrent, and in 5 life-threatening. Tuberculosis, pneumonia, and sarcoidosis were the most common preexisting lung lesions. Surgical procedures included 7 pleuropneumonectomies, 18 lobectomies and 4 wedge resections. The postoperative mortality rate was approximately 7% (2 pat.). Based on the pathological examination 4 patients had unexpectedly a bronchial carcinoma in addition to the aspergilloma. Bronchopleural fistula with persistent air space was a serious complication only for patients after pleuropneumonectomy. 23 patients including those with complex aspergilloma and pleural infection had no postoperative complications; in none of the 27 operative survivors were there any recurrent symptoms over a follow-up between one and ten years. Good-risk patients with documented aspergilloma, even asymptomatic, should be resected, because of the danger of exsanginating haemorrhage. For patients with pleural aspergillosis only the aggressive resection can provide effective long term palliation.
Insights
Surgical resection of pulmonary aspergilloma and pleural aspergillosis, caused by Aspergillus fumigatus, offers good long-term outcomes. Early intervention in good-risk patients is recommended due to hemorrhage risks.
Area of Science:
- Pulmonology
- Infectious Diseases
- Thoracic Surgery
Background:
- Pulmonary aspergilloma and pleural aspergillosis are serious infections caused by Aspergillus fumigatus.
- These conditions can lead to life-threatening complications, including severe hemoptysis.
Purpose of the Study:
- To evaluate the outcomes of major thoracic surgical procedures for pulmonary aspergilloma and pleural aspergillosis.
- To assess the efficacy of surgical resection in managing these fungal lung infections.
Main Methods:
- Retrospective review of 29 patients (24 pulmonary aspergilloma, 5 pleural aspergillosis) undergoing thoracic surgery between 1976 and 1986.
- Surgical procedures included pleuropneumonectomies, lobectomies, and wedge resections.
- Analysis of preoperative conditions, surgical procedures, postoperative complications, and long-term follow-up.
Main Results:
- The overall postoperative mortality rate was 7% (2 of 29 patients).
- Four patients were unexpectedly diagnosed with bronchial carcinoma alongside aspergilloma.
- Bronchopleural fistula was a complication primarily in pleuropneumonectomy patients.
- 23 patients had no postoperative complications, and all 27 survivors remained symptom-free during 1-10 years of follow-up.
Conclusions:
- Surgical resection is effective for pulmonary aspergilloma and pleural aspergillosis, with good long-term results.
- Asymptomatic or symptomatic good-risk patients with aspergilloma benefit from resection due to hemorrhage risk.
- Aggressive resection is crucial for effective long-term palliation in pleural aspergillosis.