Surgical treatment of pulmonary and pleuro-pulmonary Aspergillus disease

Between 6/87 and 3/92 22 out of 24 patients were treated (22 by surgery) for pulmonary and pleural Aspergillus disease. The most frequent lung disorder was tuberculosis (9 x), followed by bronchiectasis (5 x), congenital lung cysts (2 x), pneumonia with abscess formation (2 x), sarcoidosis (2 x), and bronchial cancer (4 x). More than half the patients had further severe secondary diseases. 4 patients with "simple aspergilloma" and 5 patients with "complex aspergilloma" underwent lobectomy or segmentectomy without complications or recurrence. Special surgical problems occurred in 13 patients with inflammation involving pleura and chest wall (pleuro-pulmonary aspergillosis, pleural aspergillosis) and invasive lung changes (invasive pulmonary aspergillosis). 7 patients developed an empyema after lung resection, on 4 occasions with bronchopleural fistula. In 4 cases myoplasty, in 2 cases thoracomyoplasty, on 2 occasions completion pneumonectomy with omentoplasty, in one case omentoplasty alone, and on 2 occasions decortication with pleurectomy and lung resection lead to a complete cure. 2 open window thoracostomies were constructed. In 15 cases a single operation was adequate. In 7 patients up to 3 further operations were necessary. 17 patients had haemoptysis, in 10 of these cases it was recurrent. On 7 occasions life-threatening haemorrhage took place, causing death in 2 cases. These were the only deaths resulting from the lung disease. Our results show that aggressive surgical action can be successful. Myoplasty, thoracomyoplasty, and omentoplasty are, in our view, the most suitable measures for healing pleura empyemas and bronchopleural fistulae coincident with pleuro-pulmonary aspergillosis.(ABSTRACT TRUNCATED AT 250 WORDS)