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Monaldi cavernostomy for lung aspergillosis: A case report.

Cornel Petreanu1,2, Alina Croitoru2,3, Alexandru Gibu1

  • 1Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Experimental and Therapeutic Medicine
|August 2, 2021
PubMed
Summary

Pulmonary aspergillosis complicates respiratory failure. Cavernostomy offers a safe and effective alternative to lung resection for managing hemoptysis and infection in select patients.

Keywords:
cavernostomymycetomapulmonary aspergillosispulmonary suppurationrespiratory failure

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Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Surgical Oncology

Background:

  • Pulmonary aspergillosis significantly impairs respiratory function, potentially leading to fatal complications like massive hemoptysis.
  • Treatment typically involves a combination of medical, surgical, and interventional radiology approaches.
  • Surgical resection is ideal for invasive forms (>3 cm), but not always feasible due to patient lung function.

Purpose of the Study:

  • To evaluate the efficacy and safety of cavernostomy for pulmonary aspergillosis in patients with respiratory failure where lung resection is not an option.
  • To present a case study of successful cavernostomy for managing recurrent hemoptysis and respiratory decline.

Main Methods:

  • Retrospective evaluation of four cases with lung cavernous lesions colonized by Aspergillus.
  • Focus on cases indicated for intervention due to hemoptysis and worsening respiratory failure.
  • Detailed presentation of one case undergoing cavernostomy.

Main Results:

  • Cavernostomy closure was achieved through surgical muscle flap or spontaneous scarring after bronchial fistula healing.
  • No recurrences of hemoptysis or suppurative phenomena were observed in the evaluated cases.
  • One patient with severe respiratory failure died due to superinfection; however, the presented case recovered post-cavernostomy.

Conclusions:

  • Cavernostomy appears to be an effective and safe therapeutic option for pulmonary aspergillosis with cavernous lesions when lung resection is contraindicated.
  • This procedure can successfully manage hemoptysis and improve respiratory status in carefully selected patients.