Sarcoidosis and aspergilloma. The role of surgery

Fibrocystic pulmonary disease is a common sequel of chronic pulmonary sarcoidosis, and the subsequent development of intracavitary aspergillomas is frequent, especially in black patients. Pulmonary hemorrhage from aspergilloma is second only to cardiorespiratory failure as the cause of death in sarcoidosis. Opinions regarding the role of resectional surgery are conflicting. We report observations on 38 patients with biopsy evidence of antecedent sarcoidosis and cultural or serologic identification of Aspergillus species as cause of the fungus balls. Pulmonary fibrosis was bilateral and extensive in most cases, making surgical treatment perilous. Ten patients had moderate impairment of pulmonary function. Seven had surgical resection with six satisfactory results and one death. Three patients in this category have not required surgery. Twenty-eight patients had severely compromised pulmonary function. Surgery was performed in seven because of intractable bleeding; four survived, but three later died of respiratory failure. Of the 21 in this category not treated by surgery, six survived, four died of hemorrhage and 11 of respiratory failure. Of the 37 patients with aspergilloma whose status is known, 19 are dead, 14 survived with positive precipitins and four, all treated surgically, recovered. It is concluded that surgical treatment of aspergilloma in patients with sarcoidosis should be avoided if possible, but is inescapable in a third of cases.