Elsevier

The Annals of Thoracic Surgery

Volume 80, Issue 3, September 2005, Pages 1067-1072
The Annals of Thoracic Surgery

Original article
General thoracic
Clinical Profile and Surgical Outcome for Pulmonary Aspergilloma: A Single Center Experience

https://doi.org/10.1016/j.athoracsur.2005.03.078Get rights and content

Background

This retrospective study was designed to study the clinical profile, indications, postoperative complications and long-term outcome of pulmonary aspergilloma operated in our institute.

Methods

From 1985 to 2003, 60 patients underwent surgery for pulmonary aspergilloma at Sree Chitra Tirunal Institute for Medical Sciences and Technology.

Results

The group consisted of 36 male patients and 24 female patients with a mean age of 42.7 ± 11.8 years. The most common indication for surgery was hemoptysis (93.3%). The common underlying lung diseases were tuberculosis (45%), bronchiectasis (28.3%), and lung abscess (11.6%). Fourteen patients (23%) had simple aspergilloma (SA) and 46 (77%) had complex aspergilloma (CA). The procedures performed were lobectomy (n = 55), pneumonectomy (n = 2), segmental resection (n = 2), and cavernoplasty (n = 2). One patient underwent bilateral lobectomy at 14 months interval. The operative mortality was 4.3% and 0% in CA and SA, respectively (p = 1.0). Major complications occurred in 26.1% patients of CA, whereas none occurred in SA (p = 0.052). The complications included bleeding (n = 2), prolonged air leak (n = 4), empyema (n = 4), repeated pneumothorax (n = 1), and wound dehiscence (n = 1). Three patients needed thoracoplasty. The mean follow-up period was 40 ± 24 months. The actuarial survival at 10 years was 78% and 92% for CA and SA, respectively. There was no recurrence of disease or hemoptysis.

Conclusions

Surgical resection of pulmonary aspergilloma prevents recurrence of hemoptysis. Complex aspergilloma resection was associated with low mortality but significant morbidity, whereas SA had no associated early mortality and morbidity. Long-term outcome is good for SA and satisfactory for CA.

Section snippets

Patient Population

During a 19-year period (1985 to 2003), 60 patients were surgically treated for PA at Sree Chitra Tirunal Institute for Medical Sciences and Technology. The group consisted of 36 male patients and 24 female patients with a mean age of 42.7 ± 11.8 years. The clinical record of these patients were reviewed for preoperative symptoms, chest radiography, computed tomography (CT) findings, preoperative preparation, technique of anesthesia and postoperative analgesia, surgical procedure performed,

Symptoms and Indication for Surgery

Table 1 denotes the symptoms. Hemoptysis was the most frequent indication for surgery. Hemoptysis was massive in 3 patients (5.3%) and severe in another 8 patients (14.2%); 10 of them underwent successful bronchial artery embolization, and 1 required emergency surgery for failed embolization. Moderate to minimal hemoptysis was seen in 45 patients (80.3%). Twenty patients (33.3%) had superimposed infection proven by sputum culture and received antibiotic therapy according to antibiotic

Comment

Pulmonary tuberculosis is highly prevalent in developing countries. One study [8] reported development of PA in 21% of patients after chronic pulmonary disease, of which pulmonary tuberculosis was the most common underlying pathology. Aspergilloma occurs in preexisting pulmonary cavities, predominantly in the upper lobes. The most common cavitary lesion in all series is tuberculosis; in one series [9], aspergilloma developed in as many as 17% of the patients during a 3-year observation period.

References (20)

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