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Pulmonary aspergilloma. Diagnostic and therapeutic considerations
Abstract:
Pulmonary aspergillomas usually arise from colonization and proliferation of Aspergillus in preexisting parenchymal cavities. The most common symptom in this disorder is hemoptysis, which may be massive and life-threatening. Although positive sputum cultures for Aspergillus are present in more than half of patients with aspergilloma, this is neither a sensitive nor specific diagnostic marker. Virtually all patients with this syndrome have serum precipitating antibodies to Aspergillus antigens, and this serves as a useful confirmatory test in patients with suspected aspergilloma. The routine chest roentgenograph and standard tomography remain the most important diagnostic procedures. The computed tomograph of the chest may be helpful in certain cases. Routine surgical resection of aspergillomas is not recommended but should be reserved for patients with recurrent, severe hemoptysis who can tolerate thoracotomy. Parenteral antifungal therapy has not been effective in this disease; however, selected patients may be candidates for intracavitary antifungal therapy.
Insights
Pulmonary aspergillomas, fungal infections in lung cavities, are best diagnosed with imaging and serum antibodies. Treatment focuses on severe cases, with surgery for recurrent bleeding and intracavitary antifungals as options.
Area of Science:
- Pulmonology
- Mycology
- Infectious Diseases
Background:
- Pulmonary aspergillomas result from Aspergillus colonization in lung cavities.
- Hemoptysis is the most common and potentially life-threatening symptom.
Purpose of the Study:
- To review diagnostic markers and treatment strategies for pulmonary aspergillomas.
- To emphasize the role of imaging and serology in diagnosis.
Main Methods:
- Review of diagnostic procedures including sputum cultures, serum precipitins, chest roentgenography, and computed tomography (CT).
- Evaluation of treatment options such as surgery and antifungal therapy.
Main Results:
- Sputum cultures for Aspergillus are neither sensitive nor specific.
- Serum precipitating antibodies to Aspergillus antigens are found in nearly all patients.
- Routine chest roentgenography and tomography are primary diagnostic tools; CT may assist.
- Parenteral antifungal therapy is ineffective; intracavitary therapy is an option for select patients.
Conclusions:
- Diagnosis relies on imaging and serological tests, not sputum cultures.
- Surgery is reserved for patients with severe, recurrent hemoptysis.
- Intracavitary antifungal therapy may benefit selected individuals.