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Coccidioidal pulmonary cavities with rupture

R T Cunningham, H Einstein

    The Journal of Thoracic and Cardiovascular Surgery
    |August 1, 1982
    PubMed
    Summary
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    Prompt surgical intervention is crucial for spontaneous rupture of pulmonary cavities caused by coccidioidomycosis, leading to pyopneumothorax. Early operation, alongside Amphotericin B in specific cases, improves outcomes and prevents mortality.

    Area of Science:

    • Pulmonary Medicine
    • Infectious Diseases
    • Thoracic Surgery

    Background:

    • Coccidioidomycosis can lead to spontaneous rupture of pulmonary cavities.
    • This rupture can result in a pyopneumothorax, a serious medical emergency.
    • Diagnosis and management of this condition present significant clinical challenges.

    Purpose of the Study:

    • To present findings on 23 patients with pyopneumothorax from ruptured coccidioidomycosis cavities.
    • To detail clinical, laboratory, and treatment outcomes, including surgical interventions.
    • To provide recommendations for timely diagnosis and management.

    Main Methods:

    • Retrospective review of 23 patients with spontaneous rupture of pulmonary cavities due to coccidioidomycosis.
    • Analysis of clinical presentations, laboratory results (skin tests, complement fixation titers, cultures), and treatment strategies.

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  • Detailed reporting of surgical procedures (lobectomies, partial lobectomies, pneumonectomy, decortication) and medical management (Amphotericin B).

    • Main Results:

    • Surgical treatment was performed in 21 patients, with various resection types and decortication in 17.
    • No deaths occurred among the 23 patients; three major complications were reported.
    • Laboratory tests like skin tests were not diagnostic; elevated titers and positive cultures did not warrant delaying surgery.
    • Amphotericin B was administered to 10 patients, particularly in acute phases, diabetic patients, or with limited resections.

    Conclusions:

    • Prompt surgical intervention is recommended for suspected pyopneumothorax from coccidioidomycosis.
    • Factors like delayed treatment, diabetes, and comorbidities may necessitate postponing surgery.
    • The extent of resection might be limited by pleural space contamination; Amphotericin B is a valuable adjunct in specific clinical scenarios.