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Lahiri R, Jhalani I, Kumar A, Goswami AG. Successful management of delayed postoperative lung collapse secondary to spillage of aspergilloma. BMJ Case Rep 2023; 16:e254621. [PMID: 37402589 PMCID: PMC10335511 DOI: 10.1136/bcr-2023-254621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Aspergilloma usually grows in lung cavities, although some may present with intrabronchial masses. Bronchial spillage during surgery is a known and disastrous complication of cavitary aspergilloma with bronchial communication. We present a case of a man in his 40s who developed a cavitary aspergilloma with recurrent haemoptysis almost a decade after his pulmonary tuberculosis. Following a segmentectomy for the same, the patient was extubated on table with well-expanded lung fields. Six hours later, he developed respiratory distress, and X-ray showed a complete lung collapse. An emergency bronchoscopy revealed a fungal ball obstructing the left main bronchus. The mass was successfully removed through bronchoscope, and the patient had lung expansion and uneventful recovery.
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Affiliation(s)
- Raja Lahiri
- CVTS, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Ishan Jhalani
- CVTS, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Ajay Kumar
- Cardiac Anaesthesia, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
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Otu A, Kosmidis C, Mathioudakis AG, Ibe C, Denning DW. The clinical spectrum of aspergillosis in chronic obstructive pulmonary disease. Infection 2023:10.1007/s15010-022-01960-2. [PMID: 36662439 PMCID: PMC9857914 DOI: 10.1007/s15010-022-01960-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/15/2022] [Indexed: 01/21/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. In this review, we present the clinical spectrum and pathogenesis of syndromes caused by Aspergillus in COPD namely invasive aspergillosis (IA), community-acquired Aspergillus pneumonia, chronic pulmonary Aspergillosis and Aspergillus sensitisation. Some of these entities are clearly linked to COPD, while others may coexist, but are less clearly liked directly to COPD. We discuss current uncertainties as these pertain to IA in COPD cohorts and explore areas for future research in this field.
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Affiliation(s)
- Akaninyene Otu
- grid.418161.b0000 0001 0097 2705Department of Microbiology, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX UK
| | - Chris Kosmidis
- grid.5379.80000000121662407Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M23 9LT UK
| | - Alexander G. Mathioudakis
- grid.5379.80000000121662407Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK ,grid.498924.a0000 0004 0430 9101North West Lung Centre, Wythenshawe Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Chibuike Ibe
- grid.442675.60000 0000 9756 5366Department of Microbiology, Faculty of Biological Sciences, Abia State University, Uturu, Nigeria
| | - David W. Denning
- grid.5379.80000000121662407Manchester Fungal Infection Group, University of Manchester, Manchester, UK
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3
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Volpe-Chaves CE, Venturini J, B Castilho S, S O Fonseca S, F Nunes T, T Cunha EA, M E Lima G, O Nunes M, P Vicentini A, V L Oliveira SM, Carvalho LR, Thompson L, P Mendes R, M M Paniago A. Prevalence of chronic pulmonary aspergillosis regarding time of tuberculosis diagnosis in Brazil. Mycoses 2022; 65:715-723. [PMID: 35524507 DOI: 10.1111/myc.13465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/18/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data on the prevalence of chronic pulmonary aspergillosis (CPA) in patients with active or cured tuberculosis (TB) are scarce, mainly due to diagnostic difficulties. The diagnosis of CPA is based on pulmonary symptoms and chest computed tomography (CT) scans and is considered confirmed when there is microbiological or serological evidence of Aspergillus spp. INFECTION OBJECTIVES To estimate the prevalence of CPA in patients treated or undergoing treatment for PTB, seen in two referral hospitals in Mato Grosso do Sul, Brazil. PATIENTS AND METHODS A total of 193 consecutive patients who were treated or previously treated for pulmonary tuberculosis underwent prospective evaluation: a) clinical evaluation; b) chest CT scan; c) sputum examination-culture for fungi and smears for direct mycology; d) detection of anti-Aspergillus fumigatus antibodies using an enzyme-linked immunosorbent assay Platelia® test; and e) anti-Aspergillus spp. antibodies were assessed via a DID test. RESULTS The global prevalence of CPA was 10.9% (95% confidence interval, 7.2-16.1%), but it increased with the time of TB diagnosis. The variables independently associated with CPA were previous pulmonary tuberculosis over 4 years ago and hemoptysis. Cavities, pleural thickening, and the presence of a fungal ball were the most frequent tomographic findings in patients with CPA. CONCLUSIONS The high prevalence observed and its increase over time suggest the need for continuous surveillance of CPA in patients with active or previous pulmonary tuberculosis and throughout life, with clinical, tomographic, and serological evaluations (ELISA) for a timely diagnosis and a better prognosis.
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Affiliation(s)
- Cláudia E Volpe-Chaves
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Regional Hospital of Mato Grosso do Sul, Campo Grande, Brazil
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
| | - James Venturini
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Suse B Castilho
- Regional Hospital of Mato Grosso do Sul, Campo Grande, Brazil
| | - Simone S O Fonseca
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Regional Hospital of Mato Grosso do Sul, Campo Grande, Brazil
| | - Thiago F Nunes
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
| | - Eunice A T Cunha
- Central Laboratory of Mato Grosso do Sul (LACEN-MS), Campo Grande, Brazil
| | - Gláucia M E Lima
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
| | - Maína O Nunes
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
| | - Adriana P Vicentini
- Mycoses Immunodiagnostic Laboratory, Immunology Section, Adolfo Lutz Institute, São Paulo, Brazil
| | - Sandra M V L Oliveira
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Lídia R Carvalho
- Institute of Biosciences, Botucatu-São Paulo State University (UNESP), Botucatu, Brazil
| | - Luis Thompson
- Department of Medicine, Infectious Diseases Unit, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Rinaldo P Mendes
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Tropical Diseases Department, School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Anamaria M M Paniago
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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Is there any change in disease presentation and surgical outcomes in patients with pulmonary aspergilloma? An evaluation of the time trend. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:241-249. [PMID: 36168580 PMCID: PMC9473594 DOI: 10.5606/tgkdc.dergisi.2022.21406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/16/2021] [Indexed: 11/21/2022]
Abstract
Background
This study aims to investigate the changes in the clinical and radiological presentations of pulmonary aspergilloma in patients undergoing surgery and to evaluate changes in the surgical outcomes over time.
Methods
Between January 2000 and January 2020, a total of 88 patients (69 males, 19 females; mean age: 45.4±11.2 years; range, 17 to 70 years) who underwent surgery for pulmonary aspergilloma were retrospectively analyzed. Surgeries performed were divided into two groups based on their chronological order: first period (from 2000 to 2010, n=44) and second period (from 2010 to 2020, n=44).
Results
The most frequent underlying disorder was tuberculosis (72.7%), whereas 10 patients did not have any predisposing conditions for pulmonary aspergilloma. Regarding the aspects of radiological imaging and operative findings, 22 patients had simple aspergilloma and 66 patients had complex aspergilloma. Complications and mortality rates were 33.0% and 5.7%, respectively. A statistical downward was observed in the second period compared to that in the first period regarding the rate of patients with tuberculosis history (61.4% vs. 84.1%, p=0.01). There were more patients who did not have any predisposing conditions for pulmonary aspergilloma in the second period and in the simple aspergilloma group (p=0.04 and p<0.001, respectively). Simple aspergilloma was often observed in the second period than that in the first period (31.8% vs. 18.2%). There was no significant difference between the periods regarding the type of surgical resection (p=0.506), whereas in the simple aspergilloma group, more patients underwent wedge resection (p<0.001). There were no significant differences between the periods and radiological groups in terms of complications and mortality. Patients who underwent pneumonectomy had significantly higher rates of complications and mortality (p=0.01 and p=0.03, respectively).
Conclusion
Although pulmonary aspergilloma patients who underwent surgery in the last 10 years had a lower history of tuberculosis than those who were operated in the previous 10 years, there was no change in postoperative complications and mortality rates. An increase in simple aspergilloma prevalence may reduce the rate of surgical morbidity.
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Goyal A, Khan IA, Kumar A, Bhalla AS, Sharma R, Das A, Bale M, Parshad R. Chest-Wall Collateral Embolization to Reduce Surgical Blood Loss in Peripheral Aspergillomas. Thorac Cardiovasc Surg 2022; 70:589-595. [PMID: 35263793 DOI: 10.1055/s-0042-1743591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objective of this study was to present the procedural details and digital subtraction angiography (DSA) findings of perioperative chest-wall collateral embolization (PCCE) and compare intraoperative blood loss in patients of pulmonary aspergilloma (PA) undergoing lung resection with and without PCCE. MATERIALS AND METHODS Since November 2017, we have performed PCCE in 17 patients (14 males, three females, age 34.41 ± 12.85 years) before surgery for PA (embolization group). Retrospective evaluation of these patients was done, DSA findings were noted, and perioperative parameters (surgical approach, extent of resection, operative time, blood loss, blood transfusion, morbidity grade, and length of post-operative stay) were compared with a comparative cohort of 24 patients of PA (21 males, three females, mean age 36.13 ± 12.58 years) who underwent thoracic surgery without PCCE (May 2013-November 2017) (control group) using the Mann-Whitney U test. RESULTS A total of 55 arteries were embolized in 17 patients (mean 3.23 arteries per patient). Technical success could be achieved in all patients without any procedure-related complications. The most common arteries embolized were posterior intercostal arteries (29) followed by costocervical trunk (10), superior thoracic (8), lateral thoracic (5), and internal thoracic arteries (3). The mean blood loss was significantly lower in the embolization group compared with the control group (676.47 vs. 1,264.58 mL, p = 0.015). Within the embolization group, patients who underwent video-assisted thoracoscopic surgery had even lower blood loss compared with open surgery cases (466 vs. 887.50 mL, p-value = 0.046). CONCLUSION PCCE is a simple and safe procedure, useful in reducing intra-operative blood loss in patients undergoing surgery for peripherally located PA.
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Affiliation(s)
- Ankur Goyal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Imtiyaz Ahmad Khan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Abanti Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjunath Bale
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder Parshad
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Alemu BN. Surgical Outcome of Chronic Pulmonary Aspergilloma: An Experience from Two Tertiary Referral Hospitals in Addis Ababa, Ethiopia. Ethiop J Health Sci 2021; 30:521-530. [PMID: 33897212 PMCID: PMC8054460 DOI: 10.4314/ejhs.v30i4.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Surgical management of pulmonary aspergillosis is challenging and controversial. This study is designed to assess the clinical profile, indications and surgical outcome of Pulmonary aspergilloma. Methods A retrospective cross-sectional analysis of 72 patients who underwent pulmonary resection for pulmonary aspergilloma over the period from November, 2014, to November, 2019 was done. Data on demographic, clinical and surgical out come were retrieved. Analysis was done using SPSS version 23. Chi-square test was used to assess for significance of the association between variables and surgical outcome. Results There were 46(63.9%) males and 26(36.1%) female patients with a mean age of 35.2+/-11.6 years (Range 16- 65 years). All patients were previously treated for tuberculosis. Cough, hemoptysis, and shortness of breath were the main symptoms identified. A ball of fungus together with the surrounding lung was removed. Accordingly, 32(44,4%) lobectomies, 12(16.7%) pneumonectomy, 7(9.7%) Bi-lobectomy, and 21(29.2%) cavernostomy were done. Intraoperative and Postoperative complications were seen in 8(11.1%) and 21(29.1%) patients respectively. Major morbidity encounters included massive intraoperative blood loss, prolonged air leak, empyema, air space, bronchopleural fistula, and wound infection. The hospital mortality was 3(4.2%) and the average hospital stay was 14.8days. Postoperative complications were evaluated for the difference in socio-demographic characteristics and other variables and a statistically significant difference was detected only for the location of aspergilloma, site of the lung involved and type of surgery done. (P-value =0.05.). Conclusion Pulmonary resection done for pulmonary aspergilloma showed favorable outcomes when done with good patient selection, meticulous surgical techniques, and good postoperative management. However, its long term outcome and role of antifungal treatment as adjunctive therapy for surgical resection need further investigation.
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Affiliation(s)
- Berhanu N Alemu
- Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
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Kabiri EH, Hammoumi ME, Bhairis M, Oueriachi FE, Slaoui O, Amraoui M. Clinical and surgical analysis of lobectomy for destroyed lobe of the lung: A series of 47 patients. Asian Cardiovasc Thorac Ann 2021; 29:772-778. [PMID: 33975468 DOI: 10.1177/02184923211017101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Destroyed lobe of the lung is always secondary to chronic or recurrent lung infections with irreversible damage of pulmonary parenchyma. In this study, we analyzed surgical technique, post-operative complications, mortality, and long-term outcomes of patients undergoing lobectomy of pulmonary lobe destruction. MATERIALS AND METHODS A retrospective study of 47 patients that underwent lobectomy due to a destroyed lung parenchyma between January 2010 and December 2019 were reviewed with an average follow-up period of 39 months. RESULTS The study included 47 patients with a mean age of 39.4 years. The etiology of lobe destroyed was tuberculosis in 15 (31.9%), non-tuberculosis bronchiectasis in 20 (42.5%), aspergilloma in 09 (19.1%), hydatid cyst in 2 (4.3%), and a mis-diagnosed intrabronchic foreign body in 1 (2.1%). Surgical approach was through posterolateral thoracotomy in 44 (93.6%) patients and video-assisted thoracoscopic surgery in only 3 patients. Mean operative time was 153 min and mean post-operative hospital stay was 7.9 days. The post-operative complications occurred in five (10.6%): atelectasis (n = 2), wound site infection (n = 1), prolonged air leak (n = 1), and hemothorax in one case. No post-operative mortality was noted. A good clinical result was observed in 87.2% of cases. CONCLUSION Surgical treatment of destroyed lobe is a high risk associated surgery. Tuberculosis and aspergilloma are the most common etiologies. Favorable result was obtained in selected patient with an excellent perioperative care.
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Affiliation(s)
- El Hassane Kabiri
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco.,Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco
| | - Massine El Hammoumi
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Mohamed Bhairis
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Faycal El Oueriachi
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Omar Slaoui
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Mouaad Amraoui
- Department of Thoracic Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
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Razafimanjato N, Rakotoson J, Ravoatrarilandy M, Andrianasolo R, Rajaonera A, Raveloson N, Rakotovao H. [Severity Factors of Pulmonary Aspergilloma in the Surgical Intensive Care Unit of Joseph Ravoahangy Andrianavalona Hospital, Antananarivo, Madagascar]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2021; 1:E9QE-PV02. [PMID: 35586637 PMCID: PMC9022768 DOI: 10.48327/e9qe-pv02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/06/2021] [Indexed: 11/18/2022]
Abstract
Objective This retrospective study was designed to study the clinical profile, post-operative outcome with analysis of severity factors of pulmonary aspergilloma operated in our institute. Patients and methodology During a 5-year period (June 2009 to June 2014), 34 patients underwent surgery for pulmonary aspergilloma and were admitted in the surgical intensive care unit of the CHU/JRA Antananarivo. Results The group consist of 23 male patients and 11 female patients with a mean age of 42 ± 9.9 years. In 29.4% of cases, it was a complex aspergilloma. The procedures performed were segmental resection (n = 3), lobectomy (n = 21), bi-lobectomy (n = 2), pneumonectomy (n = 7) and cavernostomy (n = 1). Median hospital stay was 4.5 ± 3 days. The postoperative lethality rate was 14.7% caused by respiratory failure, infection and underlying diseases. Main complications included bleeding, respiratory failures, and pulmonary infection. Conclusion Factors associated to increased postoperative complications included: the ASA score, decreased preoperative lung function, urgent procedures, smoking, postoperative mechanical ventilation, bleeding, hyperleukocytosis and surgery duration.
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Affiliation(s)
- N.N.M. Razafimanjato
- USFR de chirurgie thoracique, Hôpital universitaire Joseph Ravoahangy Andrianavalona (HUJRA), Faculté de médecine d'Antananarivo, Madagascar,*
| | - J.M. Rakotoson
- USFR d'anesthésie-réanimation chirurgicale, Hôpital universitaire Joseph Ravoahangy Andrianavalona (HJRA). Faculté de médecine d'Antananarivo, Madagascar
| | - M. Ravoatrarilandy
- USFR de chirurgie thoracique, Hôpital universitaire Joseph Ravoahangy Andrianavalona (HUJRA), Faculté de médecine d'Antananarivo, Madagascar
| | - R.L. Andrianasolo
- USFR de maladie infectieuse et tropicale, Hôpital universitaire Joseph Raseta Befelatanana (HJRB). Faculté de médecine d'Antananarivo, Madagascar
| | - A.T. Rajaonera
- USFR d'anesthésie-réanimation chirurgicale, Hôpital universitaire Joseph Ravoahangy Andrianavalona (HJRA). Faculté de médecine d'Antananarivo, Madagascar
| | - N.E. Raveloson
- USFR de réanimation médicale, Hôpital universitaire Joseph Raseta De Befelatanana (HJRB). Faculté de médecine d'Antananarivo, Madagascar
| | - H.J.L. Rakotovao
- USFR de chirurgie thoracique, Hôpital universitaire Joseph Ravoahangy Andrianavalona (HUJRA), Faculté de médecine d'Antananarivo, Madagascar
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Giang NT, Dung LT, Hien NT, Thiet TT, Hiep PS, Pho DC, Hung PN. Plombage for Hemoptysis Control in Pulmonary Aspergilloma: Safety and Effectiveness of Forgettable Surgery in High-Risk Patients. Ann Thorac Cardiovasc Surg 2021; 27:10-17. [PMID: 33408306 PMCID: PMC8043030 DOI: 10.5761/atcs.oa.20-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives: To evaluate plombage surgery for hemoptysis control in pulmonary aspergilloma in high-risk patients. Methods: This study was carried out on 75 pulmonary aspergilloma patients presenting with hemoptysis that underwent a plombage surgery for approximately 7 years (November 2011–September 2018) at Pham Ngoc Thach Hospital. They revisited the hospital 6 months after plombage surgery and considered plombage removal. The group whose plombage was removed was compared with that whose plombage was retained 6 and 24 months after surgery. Results: Hemoptysis reduced significantly after surgery. Hemoptysis ceased in 91.67% of the patients and diminished in 8.33% of the patients 6 months after surgery. Similarly, hemoptysis ceased in 87.32% of the patients and diminished in 12.68% of the patients 24 months after surgery. Body mass index (BMI) index, Karnofsky score, and forced expiratory volume in one second (FEV1) increased. Plombage surgery was performed with operative time of 129.5 ± 36.6 min, blood loss during operation of 250.7 ± 163.1 mL, and the number of table tennis balls of 4.22 ± 2.02. No deaths related to plombage surgery were recorded. Plombage was removed in 29 cases because of patients’ requirements (89.8%), infection (6.8%), and pain (3.4%). There were no patient developing complications after the treatment and there were no statistically significant differences between the two groups. Conclusions: Plombage surgery is safe and effective for hemoptysis control in pulmonary aspergilloma. To minimize the risk of long-term complications, surgeons should remove the plombage 6 months after the initial operation.
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Affiliation(s)
- Nguyen Truong Giang
- Department of Cardiothoracic Surgery, Military Hospital, Vietnam Military Medical University, Ha Noi, Vietnam
| | - Le Tien Dung
- Department of Thoracic Surgery, Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - Nguyen Thanh Hien
- Department of Thoracic Surgery, Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - Truong Thanh Thiet
- Department of Thoracic Surgery, Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - Phan Sy Hiep
- Department of Thoracic Surgery, Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - Dinh Cong Pho
- Department of Infection Control, Military Hospital, Vietnam Military Medical University, Ha Noi, Vietnam
| | - Pham Ngoc Hung
- Department of Epidemiology, Vietnam Military Medical University, Ha Noi, Vietnam.,Department of Training, Vietnam Military Medical University, Ha Noi, Vietnam
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10
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Lang M, Lang AL, Chauhan N, Gill A. Non-surgical treatment options for pulmonary aspergilloma. Respir Med 2020; 164:105903. [DOI: 10.1016/j.rmed.2020.105903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/17/2020] [Indexed: 01/11/2023]
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Hemoptysis from complex pulmonary aspergilloma treated by cavernostomy and thoracoplasty. BMC Surg 2019; 19:187. [PMID: 31805919 PMCID: PMC6894504 DOI: 10.1186/s12893-019-0650-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In high-risk patients with complex pulmonary aspergilloma but unable for lung resection, cavernostomy and thoracoplasty could be performed. This study aimed to evaluate this surgery compared two compressing materials. METHODS A total of 63 in high-risk patients who suffered from hemoptysis due to complex pulmonary aspergilloma and underwent cavernostomy and thoracoplasty surgery from November 2011 to September 2018 at Pham Ngoc Thach hospital were evaluated prospectively studied. Patients were allocated to two groups: the table tennis ball group and tissue expander group. We evaluated at the time of before operation, 6 months and 24 months after operation. RESULTS Tuberculosis was the most common comorbidity diseases in both groups. Upper lobe occupied almost in location. Hemoptysis symptoms plunged from time to time. Statistically significant Karnofsky score was observed in both groups. Postoperative pulmonary functions (FVC and FEV1) have remained in both groups at all time points. The remarkable results were no deaths related to surgery and low complications both short and long-term. There was no statistical significance between two groups in operative time, blood loss during operation, ICU length-stay time. Four patients died because of co-morbidity in 24 months follow-up. CONCLUSION Cavernostomy and thoracoplasty was safe and effective surgery for the treatment of complex pulmonary aspergilloma with hemoptysis in high-risk patients. No mortality related to surgery and low complications were recorded. The was no inferiority when compared two compressing materials .
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12
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Zheng S, Li X, Hu B, Li H. Is adjuvant antifungal therapy after video-assisted thoracic surgery for pulmonary aspergilloma necessary? J Thorac Dis 2018; 10:6060-6065. [PMID: 30622777 DOI: 10.21037/jtd.2018.09.151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background The aim of this current retrospective study was to assess the necessity of postoperative antifungal therapy for pulmonary aspergilloma (PA) patients who underwent video-assisted thoracic surgery (VATS) lung resection. Methods We enrolled 22 PA patients who underwent VATS lung resection between 2014 and 2018. Of these, 12 patients were prescribed antifungal agents during the perioperative period (group A), and the other 10 were treated with surgery alone without any antifungal therapy postoperatively (group B). All patients were immunocompetent. Results Seven patients (58.3%) developed postoperative complications in group A, including 2 cases of empyema (16.7%), 1 case of bronchopleural fistula (8.3%), 1 case of pneumonia (8.3%), 1 case of wound infection (8.3%), 1 case of bleeding (8.3%) and 1 case of atelectasis (8.3%). In group B, 3 patients (30%) developed postoperative complications, including 2 cases of pneumonia (20%) and 1 case of empyema (10%). There was no significant difference between the groups with respect to postoperative complications rates (P=0.23). The follow-up period ranged from 1 to 38 months (a median of 19 months), during which no hospital deaths, recurrence of disease or lesion relapses were noted in either group. Conclusions Our results suggested that postoperative adjuvant antifungal therapy has limited advantages for the surgical treatment of PA in immunocompetent patients.
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Affiliation(s)
- Shuo Zheng
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Xin Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Abstract
Fungal infections of the lung are common in endemic areas and in immunocompromised patients. Antifungal therapy is the cornerstone of medical therapy for most pulmonary fungi but surgery is an important adjunct in cases of complicated disease or resistant organisms. A multidisciplinary approach including pulmonary medicine, infectious disease, interventional radiology, and thoracic surgery is favored. This article reviews the surgical management of common fungal pulmonary infections and their sequelae.
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Affiliation(s)
- Staci Beamer
- Division of Cardiothoracic Surgery, Mayo Clinic Hospital Arizona, Phoenix, AZ, USA
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14
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Can Long-term Antifungal Therapy Be an Alternative to Surgery in Pulmonary Aspergilloma? ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2018. [DOI: 10.21673/anadoluklin.413147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Surgical treatment for pulmonary aspergilloma - early and long-term results. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 14:99-103. [PMID: 28747940 PMCID: PMC5519834 DOI: 10.5114/kitp.2017.68738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
Abstract
Introduction Pulmonary aspergilloma is a difficult therapeutic problem due to the low effectiveness of conservative treatment and high surgical morbidity. Aim To analyze the early and late results of surgical treatment for pulmonary aspergilloma. Material and methods From 2005 to 2015, 49 patients were treated surgically for pulmonary aspergilloma. Symptoms occurred in 85.7% of cases, including recurrent hemoptysis in 53%. A history of immunosuppressive therapy or chemotherapy was noted in 24.5% of patients. Complex aspergilloma was diagnosed in 79.6% of cases. Immunological test results were positive in 10.2%, and bronchoalveolar lavage samples were positive for Aspergillus species in 18.5% of cases. In 59.2% of patients, the surgical risk was assessed as ASA 3. Thirty seven patients underwent lobectomy, 3 – pneumonectomy, 7 – wedge resection, 1 – decortication, and 1 – cavernostomy. Results In-hospital mortality was 4.1%. Postoperative complications occurred in 63.3% of patients. The most common complications were: prolonged air leak (26.3%), arrhythmias (20.4%), residual pneumothorax (16.3%), respiratory failure (14.3%), atelectasis (12.3%), and bleeding (12.3%). Of the three patients that underwent pneumonectomy, one died, two required repeat thoracotomy because of bleeding, and all three required prolonged mechanical ventilation. Two patients died during the follow-up period. Aspergilloma did not recur in any of the patients who underwent pulmonary resection. Conclusions Due to the high risk of complications, surgical treatment of pulmonary aspergilloma should be restricted to symptomatic patients in whom lobectomy can be performed. The long-term results of surgical treatment are good, preoperative symptoms abate in most patients, and the rate of aspergillosis recurrence is very low.
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Yuan P, Cao JL, Huang S, Zhang C, Bao FC, Hu YJ, Lv W, Hu J. Sublobar Resection for Pulmonary Aspergilloma: A Safe Alternative to Lobectomy. Ann Thorac Surg 2017; 103:1788-1794. [DOI: 10.1016/j.athoracsur.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/07/2016] [Accepted: 01/03/2017] [Indexed: 10/19/2022]
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He G, Liu W, Gao Z, Gao Z, Gao H, Wang Y. Intervention treatment on massive hemoptysis of pulmonary aspergilloma. Exp Ther Med 2017; 13:2259-2262. [PMID: 28565835 PMCID: PMC5443225 DOI: 10.3892/etm.2017.4230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 02/24/2017] [Indexed: 12/03/2022] Open
Abstract
Retrospective analysis was carried out on intervention treatment and the effects of massive hemoptysis of pulmonary aspergilloma. Twenty-five cases diagnosed as massive hemoptysis of pulmonary aspergilloma were performed with imaging of bronchial arteries and other related blood vessels in order to assess blood vessel type and the number involved in the disease and perform embolotherapy on the offending artery. There were 68 bleeding arteries in 25 cases, of which there were 36 bronchial arteries (52.94%), 15 intercostal arteries (22.06%), 9 internal thoracic arteries (16.17%), 5 inferior phrenic arteries (7.35%), and 3 pulmonary arterial branches (4.41%) and all of them were in embolism condition. For 25 cases, 21 bleeding cases were stopped immediately (84.00%), 3 bleeding cases were stopped after the 2nd embolism, and 1 case had a small amount of hemoptysis after surgery discontinuously, which was stopped after corresponding treatment with no severe complications. Ten cases used polyvinyl alcohol (PVA) particulate embolization solely, 12 cases used PVA with spring coil and 3 cases used PVA, spring coil and N-butyl cyanoacrylate (NBCA) glue. In conclusion, patients who suffer from massive hemoptysis of pulmonary aspergilloma and whose medical treatments are not effective and who are not willing to receive surgical removal, intervention treatment is an effective method. PVA, spring coil and NBCA glue can be effectively used in hemoptysis embolism and pulmonary artery embolism can be considered when systemic embolism is not effective.
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Affiliation(s)
- Guanghui He
- Department of Interventional Therapy, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
| | - Wenyu Liu
- Department of Tuberculosis, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
| | - Zhiqiang Gao
- Department of Pharmacy, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
| | - Zhi Gao
- Department of Interventional Therapy, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
| | - Hongsheng Gao
- Department of Interventional Therapy, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
| | - Yanjie Wang
- Department of Interventional Therapy, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
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18
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Kumar A, Asaf BB, Puri HV, Lingaraju VC, Siddiqui S, Venkatesh PM, Sood J. Video-assisted thoracoscopic surgery for pulmonary aspergilloma. Lung India 2017; 34:318-323. [PMID: 28671161 PMCID: PMC5504887 DOI: 10.4103/0970-2113.209232] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Surgical management of pulmonary aspergilloma in symptomatic patients offers a significant chance of cure. Video-assisted thoracic surgery is a valid alternative for properly selected cases. We herein report our experience with thoracoscopic management of pulmonary aspergilloma. Patient and Methods: This retrospective analysis was performed on 41 patients operated between 2012 to 2015. The patient records were thoroughly analyzed for demography, clinical presentation, computed tomography, the procedure performed, post-operative complications and course during 6 month's follow up. Results: Out of total 41 patients, 23 (56%) were treated by VATS and 18 (44%) by thoracotomy. Average intraoperative blood loss was 214 ml (±106) in VATS group and 461 ml (±167) in thoracotomy. Mean operative time was 162 (±14) minutes in VATS and 239 (±12) minutes in thoracotomy group. In VATS group, postoperative complications were found in 5 patients and in 11 patients in the thoracotomy group. Average duration of chest tube was 5.43 () days in VATS group and 8.94 () days in thoracotomy group. Average length of hospital stay was 5.04 in VATS group and 6.55 days in thoracotomy group. Conclusions: VATS for pulmonary aspergilloma, if applicable, may be a safe and efficacious option in experienced hands. Simple aspergilloma, in particular, is considered to be a good indication for VATS. Some cases of complex aspergilloma may also be amenable to VATS. However, the long term results need to be further analyzed using a larger study group.
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Affiliation(s)
- Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | - Shireen Siddiqui
- Department of Infection Control, King Saud Medical City Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | - Jayashree Sood
- Department of Anaesthesiology and Pain Management, Sir Ganga Ram Hospital, New Delhi, India
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19
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Silva PDSMPD, Marsico GA, Araujo MAF, Braz FSV, Santos HTAD, Loureiro GL, Fontes A. Complex pulmonary aspergilloma treated by cavernostomy. Rev Col Bras Cir 2016; 41:406-11. [PMID: 25742406 DOI: 10.1590/0100-69912014006005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 02/10/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of cavernostomy in patients with complex fungal balls. METHODS We analyzed the medical records of patients undergoing cavernostomy between January 2005 and May 2013, evaluating: age, gender, preoperative signs and symptoms, predisposing disease, preoperative tests, location of the aspergilloma, etiologic agent, cavernostomy indication, postoperative outcome. RESULTS Ten patients were male. The mean age was 42.9 years (34-56). The most frequent symptom was repeated pulmonary bleeding. Cavernostomy was proposed for patients at high risk for lung resection. It was performed in 17 patients and all of them had pulmonary tuberculosis sequelae, with cavitations. The indication in all cases was hemoptysis and elimination of phlegm. The cavernostomies were performed in a single surgical procedure. In all 17 patients the cavity was left open after the withdrawal of the mycetoma. In all patients hemoptysis ceased immediately. Operative mortality was 9.5% (1). CONCLUSION cavernostomy is an effective treatment alternative in patients at high risk. It may be useful in some patients with complex aspergilloma, irrespective of lung function or bilateral disease. It is technically easy, has low-risk, saves parenchyma, and may be performed in a single operative time.
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Affiliation(s)
| | | | | | | | | | | | - Anderson Fontes
- Andaraí Federal Hospital, Ministry of Health, Rio de Janeiro, RJ, Brazil
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20
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Demir A, Gunluoglu MZ, Turna A, Kara HV, Dincer SI. Analysis of Surgical Treatment for Pulmonary Aspergilloma. Asian Cardiovasc Thorac Ann 2016; 14:407-11. [PMID: 17005889 DOI: 10.1177/021849230601400512] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surgery for pulmonary aspergilloma is reputed to be risky. The results of surgical treatment of pulmonary aspergilloma in 41 patients between 1988 and 2003 were evaluated retrospectively. Hemoptysis occurred in 31 patients (75.6%) and it was massive (> 300 mL in 24 hr) in 3. The underlying lung disease was tuberculosis in 35, bullous lung disease in 2, hydatid cyst in 2, and lung carcinoma in 2 patients. Lobectomy, bilobectomy, wedge resection, and pneumonectomy were performed in 27, 4, 6, and 4 patients respectively. The postoperative complication rate was 24.4%. One patient, who had a right pneumonectomy, died due to respiratory failure; the mortality rate was 2.4%. Recurrent hemoptysis was observed in only one patient. Early surgical treatment of patients with pulmonary aspergilloma resulted in a satisfactory outcome with acceptable morbidity, low mortality, and effective prevention of recurrent hemoptysis. Pneumonectomy has a high morbidity, thus it should be avoided if possible.
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Affiliation(s)
- Adalet Demir
- Yuzyil mah. Kisla Cad. Yesil zengibar sitesi, A-3 Blok, D-9 Bagcilar, Istanbul, Turkey.
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21
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Kurul IC, Demircan S, Yazici U, Altinok T, Topcu S, Unlü M. Surgical Management of Pulmonary Aspergilloma. Asian Cardiovasc Thorac Ann 2016; 12:320-3. [PMID: 15585701 DOI: 10.1177/021849230401200409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Records of 59 patients (41 males and 18 females) who underwent 70 operations for pulmonary aspergilloma in a 23-year period were examined retrospectively. Sixty-three operations were for primary treatment of pulmonary aspergilloma, and 7 were for complications of surgery. Twenty-six postoperative complications occurred in 19 patients. Three lobectomies that resulted in bronchopleural fistula were managed by intercostal muscle-flap closure and partial thoracomyoplasty. Two patients died within the first week of surgery. Surgery is the treatment of choice for most patients with pulmonary aspergilloma. Selective bronchial artery embolization is helpful only in combating hemoptysis, and this has been considered a temporary measure in most reports. Thus, open thoracotomy and anatomical resection are recommended as early as possible after the diagnosis is established.
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Affiliation(s)
- Ismail C Kurul
- Department of Thoracic Surgery, Gazi University Medical Faculty, Ankara, Turkey.
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22
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Mohapatra B, Sivakumar P, Bhattacharya S, Dutta S. Surgical treatment of pulmonary aspergillosis: A single center experience. Lung India 2016; 33:9-13. [PMID: 26933300 PMCID: PMC4748676 DOI: 10.4103/0970-2113.173077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Aspergillus fumigatus is a saprophytic fungus which colonizes in the cavitary lesions in the lungs. In our part of the world, where tuberculosis is endemic, the healed tubercular cavities form a good nidus for this fungus. The fungus forms a fungal ball or aspergilloma within the cavity, which erodes the walls of the cavity and causes hemoptysis by erosion of the bronchial vessels. Hemoptysis is the main symptom. Antifungal agents are not useful against the fungal ball. Surgery in the form of lobectomy is the primary treatment. Surgery for aspergilloma is known to be risky because of intra-pleural adhesions, obliteration of the interlobar fissures, massive hemorrhage during dissection and poor pulmonary reserve of the patient due to the underlying disease. MATERIALS AND METHODS Clinical presentation, radiological investigations, operative techniques, postoperative outcome, and follow-up of 24 cases of pulmonary aspergilloma treated surgically were studied prospectively between August 2010 and July 2013 at IPGMER and SSKM Hospital, Kolkata. RESULTS There were 15 male (62.5%) and 9 female (37.5%) patients. Mean age of the study population was 34.54 years. All the patients had complex aspergilloma. Tuberculosis was the underlying disease in 22 patients (91%). Hemoptysis was the main symptom in 79.16% cases. Chest X-ray was the first investigation, which gave a clue to the diagnosis. Computed tomography scan was diagnostic in all cases. Lobectomy was done in 16 patients (66.67%). There was one mortality and the overall complication was 33.33%. The average follow-up period was 21.65 months, during which there was no mortality and no recurrence of hemoptysis in these patients. CONCLUSIONS Though surgery for aspergilloma is considered to be risky, excision of the cavity along with the involved lobe can be done with acceptable morbidity and mortality to provide the patient complete cure and symptom-free survival.
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Affiliation(s)
- Biswajeet Mohapatra
- Department of Cardiothoracic and Vascular Surgery, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Poornima Sivakumar
- Department of Cardiothoracic and Vascular Surgery, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Subhankar Bhattacharya
- Department of Cardiothoracic and Vascular Surgery, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Santanu Dutta
- Department of Cardiothoracic and Vascular Surgery, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
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23
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Madansein R, Parida S, Padayatchi N, Singh N, Master I, Naidu K, Zumla A, Maeurer M. Surgical treatment of complications of pulmonary tuberculosis, including drug-resistant tuberculosis. Int J Infect Dis 2016; 32:61-7. [PMID: 25809758 DOI: 10.1016/j.ijid.2015.01.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 11/28/2022] Open
Abstract
Surgery for drug-resistant tuberculosis has been shown to be safe and effective, with similar level of mortalities associated with surgical intervention observed with that for lung cancer. While surgery has been an option to treat TB in the pre-antibiotic era, it is now increasingly used to treat complications of pulmonary TB, particularly in patients with drug-resistant TB who do not respond to medical treatment. The two most frequent indications for lung resection in drug- resistant TB, are i) failed medical treatment with persistent sputum positivity or ii) patients who have had medical treatment and are sputum negative, but with persistent localized cavitary disease or bronchiectasis. Massive hemoptysis is a potentially life-threatening complication of TB. Lung resection is potentially curative in patients with massive hemoptysis and cavitary or bronchiectatic disease. Bronchial artery embolization in these patients has a high success rate but bears also the risk of recurrence. Lung resection can be safely undertaken in selected patients with HIV co-infection and pulmonary complications of TB. Ambulatory drainage is a novel, safe, affordable and effective method of draining a chronic TB associated empyema thoracis. We review here the current surgical treatment of the complications of pulmonary TB and discuss the experience from the Durban Cardiothoracic Surgery Unit for the surgical treatment of patients with complicated pulmonary TB.
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Affiliation(s)
- Rajhmun Madansein
- Department of Cardiothoracic Surgery, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, King Dinuzulu Hospital, Dept of Health, KwaZulu-Natal Province, Durban, South Africa; DR-TB Department, King Dinuzulu Hospital, Dept of Health, KwaZulu-Natal Province, Durban, South Africa; MSC_Durban Team.
| | - Shreemanta Parida
- Division of Therapeutic Immunology, TIM, Dept of Laboratory Medicine, Karolinska Institutet.
| | - Nesri Padayatchi
- MSC_Durban Team; Centre for AIDS Prevention Research in South Africa (CAPRISA), University of KwaZulu-Natal, SAMRC CAPRISA HIV - TB Pathogenesis and Treatment Research Unit, Durban, South Africa.
| | - Nalini Singh
- DR-TB Department, King Dinuzulu Hospital, Dept of Health, KwaZulu-Natal Province, Durban, South Africa; MSC_Durban Team.
| | - Iqbal Master
- DR-TB Department, King Dinuzulu Hospital, Dept of Health, KwaZulu-Natal Province, Durban, South Africa; MSC_Durban Team.
| | - Kantharuben Naidu
- DR-TB Department, King Dinuzulu Hospital, Dept of Health, KwaZulu-Natal Province, Durban, South Africa; MSC_Durban Team.
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London Medical School, London, UK.
| | - Markus Maeurer
- Division of Therapeutic Immunology, TIM, Dept of Laboratory Medicine, Karolinska Institutet; Center for allogeneic stem cell transplantation (CAST), Karolinska Hospital, Stockholm, Sweden.
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24
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Sapienza LG, Gomes MJL, Maliska C, Norberg AN. Hemoptysis due to fungus ball after tuberculosis: A series of 21 cases treated with hemostatic radiotherapy. BMC Infect Dis 2015; 15:546. [PMID: 26612361 PMCID: PMC4660718 DOI: 10.1186/s12879-015-1288-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 11/24/2015] [Indexed: 11/10/2022] Open
Abstract
Background In patients who are not amenable to surgical resection (cavernostomy), it is difficult to achieve palliation of hemoptysis from pulmonary aspergilloma. There are only 9 cases with a short follow-up that have reported the use of radiotherapy for hemoptysis in this scenario. Methods A retrospective series of 21 patients with chronic necrotizing pulmonary aspergillosis were treated with radiotherapy (20 Gray) from 1990 to 2002. The outcome measures were the period from tuberculosis treatment to the onset of hemoptysis, hemoptysis resolution rate, change in Zubrod performance status after 30 days of the completion of radiotherapy, local failure-free survival, and overall survival. Results The median time between tuberculosis treatment and the onset of hemoptysis due to aspergilloma was 9 years. After radiotherapy, general status improved and the hemoptysis resolved in all patients. During the follow-up period, 4 failures occurred, with a 5-year local failure-free survival rate of 82 % and a 5-year overall survival rate of 59 %. Of these failures, 2 patients died due to recurrence of the hemoptysis, and 2 were rescued (using cavernostomy and reirradiation). The presence of chronic obstructive pulmonary disease (COPD) (p = 0.021) and female gender (p = 0.032) were negatively associated with overall survival. None of the variables was related to local control. Conclusions Based on these long-term data, radiotherapy is a potential option for controlling bleeding due to fungus balls. Female patients and COPD were associated with lower survival.
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Affiliation(s)
- Lucas G Sapienza
- Radiation Oncology Department, Clínicas Oncológicas Integradas (COI-RJ), Rio de Janeiro, Brazil. .,Radiation Oncology Department, A.C. Camargo Cancer Center, São Paulo, Brazil.
| | - Maria José L Gomes
- Radiation Oncology Department, Hospital Federal Servidores do Estado do Rio de Janeiro (HFSE-RJ), Rio de Janeiro, Brazil.
| | - Carmelindo Maliska
- Nuclear Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
| | - Antonio N Norberg
- Infectology Department, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, Brazil.
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25
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Hata Y, Otsuka H, Makino T, Koezuka S, Sugino K, Shiraga N, Tochigi N, Shibuya K, Homma S, Iyoda A. Surgical treatment of chronic pulmonary aspergillosis using preventive latissimus dorsi muscle flaps. J Cardiothorac Surg 2015; 10:151. [PMID: 26541145 PMCID: PMC4635576 DOI: 10.1186/s13019-015-0354-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 10/28/2015] [Indexed: 11/26/2022] Open
Abstract
Background Surgery for chronic pulmonary aspergillosis is often technically risky. The choice of immediate thoracoplasty or muscle flap plombage to prevent postoperative space problems remains controversial. This study focused on the use of muscle flaps to prevent postoperative complications. Methods During an 8-year period (2004 to 2012), all patients surgically treated for chronic pulmonary aspergillosis were enrolled in this retrospective study. Concomitant intrathoracic transposition of the latissimus dorsi muscle flap has been performed since 2011. The clinical records of these patients were reviewed retrospectively. Results From 2004 to 2012, 16 patients were treated for chronic pulmonary aspergillosis. Fifteen patients received lobectomies and one had a partial resection. A preventive latissimus dorsi muscle flap was used in 6 patients (37 %). No postoperative deaths occurred. Prolonged air leaks appeared in 2 patients without muscle flaps, resulting in empyema in both. None of the patients with preventive muscle flaps suffered prolonged air leaks and subsequent empyema. In the outpatient clinic, late onset air leaks developed in 2 patients, one of whom had a lobectomy with muscle flap while the other had a lobectomy without muscle flap. Residual pleural space persisted in these two patients and Aspergillus infection later recurred. Conclusions Concomitant latissimus dorsi muscle flaps may be effective for the prevention of prolonged air leaks and subsequent empyema. Late onset air leaks are problematic.
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Affiliation(s)
- Yoshinobu Hata
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan.
| | - Hajime Otsuka
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan.
| | - Takashi Makino
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan.
| | - Satoshi Koezuka
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan.
| | - Keishi Sugino
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan.
| | - Nobuyuki Shiraga
- Department of Radiology, Toho University School of Medicine, Tokyo, Japan.
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo, Japan.
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo, Japan.
| | - Sakae Homma
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan.
| | - Akira Iyoda
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan.
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Cavernostomy for Pulmonary Aspergillosis Associated with Destroyed Lung after Surgery for Lung Cancer: Report of 3 Cases. Case Rep Surg 2015; 2015:614795. [PMID: 26576311 PMCID: PMC4630383 DOI: 10.1155/2015/614795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 09/28/2015] [Accepted: 09/28/2015] [Indexed: 11/17/2022] Open
Abstract
Slow, progressive, and destructive changes in the residual lung after surgery for lung cancer, known as “destroyed lung,” are delayed nonrecurrent complications. Destroyed lung can be a difficult condition to treat due to repeated infections and is therefore a complication that should not be ignored. We had three cases of intractable pulmonary aspergillosis difficult to treat associated with destroyed lung, after lung cancer surgery. Two of these patients followed a characteristic clinical course, which started with a cystic change just below the pleura and subsequently led to respiratory failure and death due to repeated infections. The third patient followed a similar clinical course and is currently under regular follow-up. Our cases suggest that concomitant occurrence of severe complications following surgery for lung cancer, such as destroyed lung and pulmonary aspergillosis, should be monitored because these complications can lead to respiratory failure and fatal clinical course. Radical surgery is not possible, especially when medical treatment is ineffective in controlling repeated infections and the patient's general condition is worsened due to prolonged chronic inflammation. Therefore, aggressive surgical intervention should be considered before patients worsen.
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El Hammoumi MM, Slaoui O, El Oueriachi F, Kabiri EH. Lung resection in pulmonary aspergilloma: experience of a Moroccan center. BMC Surg 2015; 15:114. [PMID: 26475478 PMCID: PMC4608121 DOI: 10.1186/s12893-015-0103-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 10/14/2015] [Indexed: 11/12/2022] Open
Abstract
Background This study was conducted to determine the efficacy of surgery in the treatment of complex aspergilloma comparatively with simple aspergilloma. Methods From January 2006 to December 2014, 115 cases of pulmonary aspergilloma were admitted in our department. One operation on one side was counted as one case and the patients were divided into two groups. In group A: 61 cases of complex aspergilloma. In group B: 50 patients underwent 54 cases of lung resection for simple aspergilloma. People who underwent arteriography and embolization were excluded. Surgical treatment was indicated when 1) recurrent aspergilloma-related hemoptysis, 2) definite simple or complex aspergilloma and 3) a simultaneous bilateral aspergilloma. Results People with complex aspergilloma were big smokers with lower BMI, and had reduced lung function parameters. The main symptoms were repeated hemoptysis, chronic cough, abundant purulent expectoration and respiratory infections. Lobectomy was the most performed indication. In group B, number of wedge resections was larger than group A with statistical significant difference (p = 0.001). In the post-operative course morbidity was higher in group A (16 %) vs (9 %) in group B with statistical difference (p = 0.026). The median follow-up was 30 months (range 19–52 months). The median duration of chest tube drainage was 4 days. The duration of chest tube drainage was longer in the group A (4.7 ± 1.4 versus 2.9 ± 1.3; p = 0.005). The prolonged postoperative air leakage occurred more frequently in group A (14.75 %; versus 1.8 % p = 0.015). In group A, 3 cases and 2 in group B underwent a secondary operation for post operative hemothorax. Bronchopleural fistula occurred exclusively in group A (n = 4). Conclusions The surgical resection should be used in a multidisciplinary approach. Preoperative Interventional therapies could optimize the conditions for the operation. Total surgical resection must be the treatment of choice of localized causative lesions.
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Affiliation(s)
- Mohammed Massine El Hammoumi
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Riad 10100, Rabat, Morocco. .,Center of doctoral studies, Faculty of Medecine and Pharmacy, Mohamed V University, Rabat, Morocco.
| | - Omar Slaoui
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Riad 10100, Rabat, Morocco
| | - Fayçal El Oueriachi
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Riad 10100, Rabat, Morocco
| | - El Hassane Kabiri
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Riad 10100, Rabat, Morocco.,Center of doctoral studies, Faculty of Medecine and Pharmacy, Mohamed V University, Rabat, Morocco
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Mohapatra B, Sivakumar P, Bhattacharya S, Dutta S. Surgical treatment of pulmonary aspergilloma: a single-center experience. Indian J Thorac Cardiovasc Surg 2015. [DOI: 10.1007/s12055-014-0306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mortensen KH, Babar JL, Balan A. Multidetector CT of pulmonary cavitation: filling in the holes. Clin Radiol 2015; 70:446-56. [PMID: 25623513 DOI: 10.1016/j.crad.2014.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 12/03/2014] [Accepted: 12/11/2014] [Indexed: 12/17/2022]
Abstract
Pulmonary cavitation causes significant morbidity and mortality. Early diagnosis of the presence and aetiology of a cavity is therefore crucial in order to avoid further demise in both the localized pulmonary and systemic disorders that may manifest with pulmonary cavity formation. Multidetector CT has become the principal diagnostic technique for detecting pulmonary cavitation and its complications. This review provides an overview of the aetiologies and their imaging findings using this technique. Combining a literature review with case illustration, a synopsis of the different imaging features and constellations is provided, which may suggest a particular cause and aid the differentiation from diseases with similar findings.
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Affiliation(s)
- K H Mortensen
- University Department of Radiology, Cambridge University, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
| | - J L Babar
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - A Balan
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
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Surgical Therapy of Pulmonary Aspergillomas: A 30-Year North American Experience. Ann Thorac Surg 2014; 97:432-8. [DOI: 10.1016/j.athoracsur.2013.10.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 10/12/2013] [Accepted: 10/18/2013] [Indexed: 11/18/2022]
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31
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Godet C, Philippe B, Laurent F, Cadranel J. Chronic Pulmonary Aspergillosis: An Update on Diagnosis and Treatment. Respiration 2014; 88:162-74. [DOI: 10.1159/000362674] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 04/01/2014] [Indexed: 11/19/2022] Open
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Airway and parenchymal manifestations of pulmonary aspergillosis. Respir Med 2013; 107:1113-23. [PMID: 23702091 DOI: 10.1016/j.rmed.2013.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 02/04/2013] [Accepted: 03/18/2013] [Indexed: 01/15/2023]
Abstract
Pulmonary aspergillosis encompasses a heterogeneous group of mycoses that result from either colonisation or pathogenic damage of lung tissue by Aspergillus fungi. These clinical entities range from relatively benign saprophytic hypersensitivity associated with fungal inhabitation to life threatening invasive disease. The diagnosis of pulmonary disorders related to Aspergillus is on the increase and it is more important than ever those both general and respiratory physicians have a good understanding of these disorders. This paper reviews the contemporary understanding of the clinical, radiographic and histopathological aspects of pulmonary aspergillosis.
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Alberti N, Frulio N, Trillaud H, Jougon J, Jullie ML, Palussiere J. Pulmonary aspergilloma in a cavity formed after percutaneous radiofrequency ablation. Cardiovasc Intervent Radiol 2013; 37:537-40. [PMID: 23636252 DOI: 10.1007/s00270-013-0631-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 03/29/2013] [Indexed: 01/15/2023]
Abstract
We report two cases of pulmonary aspergilloma (PA) in a cavity formed after percutaneous radiofrequency ablation (PRFA), a rare complication that has only been described once in the literature. The first patient was a 59-year-old white woman treated for a secondary lung nodule of an advanced hepatocellular carcinoma. One month after PRFA, a consolidation of a cavity was noticed with an "air crescent sign," and aspergilloma serology was highly positive. A bisegmentectomy was performed due to the proximity of the lesion to mediastinal vessels and the absence of significant regression after antifungal treatment. Histological examination confirmed the diagnosis of PA. The second patient was a 61-year-old white man followed-up for a non-small-cell lung cancer. A cavitation with thick margins in the ablation zone was noticed 6 months after PRFA. A biopsy was performed, and aspergilloma was diagnosed. Medical treatment with itraconazole was administered for 13 months, and there was significant regression.
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Affiliation(s)
- N Alberti
- Department of Radiology, CHU de Bordeaux, Hôpital Saint-André, 33076, Bordeaux, France,
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Abstract
Aspergillomas are fungal balls within lung cavities. The natural history is variable. Hemoptysis is a dangerous sequela. Medical therapy is ineffective because of the lack of a lesion blood supply. Randomized trials are lacking. Surgery should be the treatment of choice in cases of hemoptysis, and even in asymptomatic patients, if lung function is not severely compromised. Cavernostomy and cavernoplasty may be options for high-risk patients. Percutaneous therapy should be reserved for patients who are not fit for surgery. Bronchial artery embolization is appropriate for symptomatic patients not suitable for surgery. Embolization could be considered a preoperative and temporary strategy.
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Alifano M, Gaucher S, Rabbat A, Brandolini J, Guinet C, Damotte D, Regnard JF. Alternatives to resectional surgery for infectious disease of the lung: from embolization to thoracoplasty. Thorac Surg Clin 2013; 22:413-29. [PMID: 22789603 DOI: 10.1016/j.thorsurg.2012.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Surgical treatment of lung diseases is based on removal of the affected lung tissue, achieved by atypical or anatomic lung resection. Infectious lung diseases are generally treated by medical therapy, including medications, chest physiotherapy, bronchoscopic toilet, and respiratory rehabilitation. Surgical management of infectious disease of the lung is integrated in the multispecialty care. This article focuses exclusively on nonresectional surgery and other alternatives to lung resection and addresses bacterial infection and fungal disease of the lung.
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Affiliation(s)
- Marco Alifano
- Department of Thoracic Surgery, Hôtel-Dieu Hospital, Paris Descartes University, 1 Place du Parvis Notre Dame, 75181 Paris, France
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Pulmonary Aspergillosis: Therapeutic Management and Prognostic Factors from 16 Years of Monocenter Experience. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 755:225-36. [DOI: 10.1007/978-94-007-4546-9_29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Pulmonary infections imitating lung cancer: clinical presentation and therapeutical approach. Ir J Med Sci 2012; 182:73-80. [PMID: 22592566 DOI: 10.1007/s11845-012-0831-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 04/30/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pulmonary infections occasionally present with infectious pseudotumour of the lung not easily distinguishable from true pulmonary neoplasm. In such cases, radiographic findings and clinical manifestation are highly suggestive of lung cancer. These inflammatory lung lesions cause significant diagnostic problems and appropriate therapy is often considerably delayed. We therefore report on our experience with infectious pseudotumour of the lung caused by bacterial, mycobacterial and fungal pulmonary infections. METHODS In a retrospective case series, patients with lung infections simulating pulmonary carcinoma were identified. Clinical presentation, radiological features, surgical procedures and outcome were analysed. RESULTS There were seven male and six female patients with a mean age of 53 years. Presumed pulmonary carcinoma and hemoptysis were main reasons for hospital admission. Procedures performed were video-assisted thoracoscopic wedge resection (6), lobectomy (5), video-assisted thoracoscopic lobectomy and open wedge resection each in one case. Pathologic examination of the obtained specimens revealed tuberculoma (5), aspergilloma (3), pulmonary actinomycosis related pseudotumour (3) and coccidioidoma (2). Following definite diagnosis, patients with tuberculosis and fungal infections received antituberculotic and antifungal medications, respectively. Patients suffering from pulmonary actinomycosis received penicillin. There was no in-hospital mortality. One re-thoracotomy was mandatory because of pleural empyema. CONCLUSIONS Pulmonary infections simulating lung cancer require surgical removal both for establishing definite diagnosis and to manage complications like haemoptysis and ongoing contamination of the airways by infectious agents. Whenever feasible, limited thoracoscopic resections are preferable. Following definite diagnosis antimicrobial drug therapy for a sufficient length of time is mandatory.
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Mordant P, Badia A, Le Pimpec-Barthes F, Riquet M. [Thoracic surgery in tuberculosis and non-tuberculous mycobacterial diseases]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:77-83. [PMID: 22361064 DOI: 10.1016/j.pneumo.2012.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2011] [Indexed: 05/31/2023]
Abstract
Tuberculosis and non-tuberculous mycobacteria are common indications of pleural and mediastinal surgery on a diagnostic intend. However, parenchymatous resection on a curative intend has been proven to benefit to patients with multiresistant tuberculosis in adjunction with prolonged antibiotic treatment. Furthermore, tuberculosis sequelae, i.e. destroyed lung, Aspergillus-infected cavitary tuberculosis, and related hemoptysis are eradicated by a surgical management after careful medical preparation. Finally, surgical resection of localized Mycobacterium avium and M. xenopii infections is associated with a high rate of sputum conversion and a low morbidity.
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Affiliation(s)
- P Mordant
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20 rue Leblanc, Paris, France
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Igai H, Kamiyoshihara M, Nagashima T, Ohtaki Y. Pulmonary Aspergilloma Treated by Limited Thoracoplasty with Simultaneous Cavernostomy and Muscle Transposition Flap. Ann Thorac Cardiovasc Surg 2012; 18:472-4. [DOI: 10.5761/atcs.cr.11.01757] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
The treatment of patients with non- Hodgkin’s lymphoma (NHL) is often the treatment of elderly patients, as most patients are older than 65 years at diagnosis. These elderly patients present particular therapeutic challenges, because they may be more frail and at greater risk of treatment-related toxicity, especially anthracycline-related cardiotoxicity, than younger patients. The following two case studies illustrate the challenges and therapeutic decision-making in managing elderly patients with an aggressive and an indolent form of lymphoma.
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Ruiz Júnior RL, de Oliveira FHS, Piotto BLB, Muniz FAESDSL, Cataneo DC, Cataneo AJM. Surgical treatment of pulmonary aspergilloma. J Bras Pneumol 2011; 36:779-83. [PMID: 21225182 DOI: 10.1590/s1806-37132010000600016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 06/25/2010] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to analyze the outcome of surgical treatment of pulmonary aspergilloma. To that end, we evaluated 14 adult patients so treated between 1981 and 2009 at the Botucatu School of Medicine University Hospital, in the city of Botucatu, Brazil. Data were collected from the medical records of the patients. Ten patients (71%) presented with simple pulmonary aspergilloma, and 4 (29%) presented with complex pulmonary aspergilloma. Hemoptysis was the most common symptom, and tuberculosis was the most prevalent preexisting lung disease. Two patients (14%) underwent surgery on more than one occasion. There were no intraoperative deaths. Half of the patients developed postoperative complications, prolonged air leak and empyema being the most common.
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Affiliation(s)
- Raul Lopes Ruiz Júnior
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil.
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Fatal Hemoptysis due to Chronic Cavitary Pulmonary Aspergillosis Complicated by Nontuberculous Mycobacterial Tuberculosis. Case Rep Infect Dis 2011; 2011:837146. [PMID: 22567480 PMCID: PMC3336246 DOI: 10.1155/2011/837146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 06/10/2011] [Indexed: 11/18/2022] Open
Abstract
A 51-year-old man, with a history of severe COPD and bilateral pneumothorax, who was under treatment for pulmonary tuberculosis due to mycobacterium avium, was admitted due to high-grade fever, weight loss, cough, and production of purulent sputum, for almost one month without any special improvement despite adequate antibiotics treatment in outpatient setting. A CT scan revealed multiple consolidations, fibrosis, scaring, and cavitary lesions in both upper lobes with newly shadows which were fungus balls inside them. Aspergillus flavius was isolated in three sputum samples, a diagnosis of chronic cavitary pulmonary aspergillosis was made, and treatment with intravenous amphotericin B was started. An initially clinical improvement was noted, and a first episode of minor hemoptysis was treated with conservative measures. Unfortunately a second major episode of hemoptysis occurred and he died almost immediately. Aspergilloma is defined as the presence of a fungus ball inside a preexisting pulmonary cavity or dilated airway and is one of the clinical conditions associated with the clinical spectrum of pulmonary colonization. Tuberculosis is the most common underling disease. Hemoptysis is the most common symptom. Antifungal antibiotics, surgical interventions, bronchial arteries embolization, and intracavity infusion of antibiotics have been proposed without always adequate sufficiency.
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Nikolousis E, Velangi M. Two cases of aspergillus endocarditis in non neutropenic children on chemotherapy for acute lymphoblastic leukaemia. Hematol Rep 2011; 3:e7. [PMID: 22184529 PMCID: PMC3238470 DOI: 10.4081/hr.2011.e7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/08/2011] [Accepted: 06/08/2011] [Indexed: 11/23/2022] Open
Abstract
Fungal endocarditis (FE) is a rare complication in immunocompromised patients which is difficult to diagnose and has been characterized by excessive mortality (> 50%) and morbidity, regardless of treatment. The lack of clinical trials due to the small number of cases contributes further to a poor outcome. In our two cases of aspergilllus endocarditis we reviewed the clinical features, echocardiographic findings, microbiologic data, treatment, and outcome of these 2 cases and provide a current characterization of the syndrome. In this paper we have demonstrated the diversity of presentation of a critical fungal infection in immunocompromised but non neutropenic paediatric patients. The prompt diagnosis and initiation of treatment is crucial for a favourable outcome along with the use of double antifungal treatment with liposomal amphotericin and voriconazole initially which could be later switched to oral voriconazole with a good tissue penetration. Histological samples as well as radiological evidence and echocardiograms should be reviewed by experienced clinicians in order to aid diagnosis and promptly initiate treatment for these patients in order to achieve a favourable outcome.
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Limper AH, Knox KS, Sarosi GA, Ampel NM, Bennett JE, Catanzaro A, Davies SF, Dismukes WE, Hage CA, Marr KA, Mody CH, Perfect JR, Stevens DA. An official American Thoracic Society statement: Treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med 2011; 183:96-128. [PMID: 21193785 DOI: 10.1164/rccm.2008-740st] [Citation(s) in RCA: 358] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With increasing numbers of immune-compromised patients with malignancy, hematologic disease, and HIV, as well as those receiving immunosupressive drug regimens for the management of organ transplantation or autoimmune inflammatory conditions, the incidence of fungal infections has dramatically increased over recent years. Definitive diagnosis of pulmonary fungal infections has also been substantially assisted by the development of newer diagnostic methods and techniques, including the use of antigen detection, polymerase chain reaction, serologies, computed tomography and positron emission tomography scans, bronchoscopy, mediastinoscopy, and video-assisted thorascopic biopsy. At the same time, the introduction of new treatment modalities has significantly broadened options available to physicians who treat these conditions. While traditionally antifungal therapy was limited to the use of amphotericin B, flucytosine, and a handful of clinically available azole agents, current pharmacologic treatment options include potent new azole compounds with extended antifungal activity, lipid forms of amphotericin B, and newer antifungal drugs, including the echinocandins. In view of the changing treatment of pulmonary fungal infections, the American Thoracic Society convened a working group of experts in fungal infections to develop a concise clinical statement of current therapeutic options for those fungal infections of particular relevance to pulmonary and critical care practice. This document focuses on three primary areas of concern: the endemic mycoses, including histoplasmosis, sporotrichosis, blastomycosis, and coccidioidomycosis; fungal infections of special concern for immune-compromised and critically ill patients, including cryptococcosis, aspergillosis, candidiasis, and Pneumocystis pneumonia; and rare and emerging fungal infections.
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Khan MA, Dar AM, Kawoosa NU, Ahangar AG, Lone GN, Bashir G, Bhat MA, Singh S. Clinical profile and surgical outcome for pulmonary aspergilloma: nine year retrospective observational study in a tertiary care hospital. Int J Surg 2011; 9:267-71. [PMID: 21252003 DOI: 10.1016/j.ijsu.2011.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 12/08/2010] [Accepted: 01/08/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND The indications and the outcome of surgery for pulmonary aspergilloma remain highly controversial. This retrospective observational study was conducted to study the clinical profile, indications, post-operative complications and long term outcome of patients having pulmonary aspergilloma. METHODS From January 2000 to October 2008, 52 patients underwent surgery for pulmonary aspergilloma at our tertiary care institute. RESULTS The group consisted of 32 males and 20 females with a mean age of 39.3 ± 11.2 years. The most common indication for surgery was hemoptysis (96.15%). The underlying lung diseases were tuberculosis (75%), bronchiectasis (5.76%), and lung abscess (5.76%). In one patient (2%), concomitant ruptured lung hydatid cyst and an aspergilloma was present. The procedures performed were lobectomy (n = 43), bilobectomy (n = 3). pneumonectomy (n = 3), segmental resection (n = 3). The post-operative mortality was 1.92% (one patient). Overall complications occurred in 12 (23.07%) patients. The complications included prolonged air leak (n = 6), bleeding (n = 3), empyema (n = 1), repeated pneumothorax (n = 1), and wound dehiscence (n = 1). The mean follow-up period was 38 ± 18.6 months. There was no recurrence of disease or hemoptysis. CONCLUSION Pulmonary aspergilloma is common in developing countries like India in which there is high prevalence of pulmonary tuberculosis. Surgical resection of pulmonary aspergilloma is effective in preventing recurrence of symptoms including hemoptysis. We recommend early surgical resection of symptomatic aspergilloma with reasonable complications. Pre-operative preparation of the patients, meticulous surgical technique and post-operative chest physiotherapy reduces the rate of complications. Complications may still occur and are largely related to the underlying lung pathology; however, the long term outcome is good.
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Affiliation(s)
- Mubashir Ali Khan
- Department of Cardiothoracic and Vascular Surgery, Sher-i-Kashmir-Institute-of-Medical-Sciences, Soura, Srinagar, Kashmir, 190011, India
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Sagan D, Goździuk K, Korobowicz E. Predictive and Prognostic Value of Preoperative Symptoms in the Surgical Treatment of Pulmonary Aspergilloma. J Surg Res 2010; 163:e35-43. [DOI: 10.1016/j.jss.2010.06.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 06/11/2010] [Accepted: 06/15/2010] [Indexed: 10/19/2022]
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Abstract
Hemoptysis and thoracic fungal infections are infrequent but challenging problems, especially when encountered in the emergency setting. The evaluation and management of massive and nonmassive hemoptysis is described with special attention to radiologic, bronchcoscopic, and surgical interventions. The important principles of airway control, stabilization, and definitive management are emphasized. Endemic and opportunistic fungal infections are more common than they seem. The role of the surgeon is to assist in diagnosis, evaluate and treat pulmonary nodules, and consider resectional therapy for mycetoma and invasive fungal infections in selected candidates.
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Sagan D, Goździuk K. Surgery for Pulmonary Aspergilloma in Immunocompetent Patients: No Benefit From Adjuvant Antifungal Pharmacotherapy. Ann Thorac Surg 2010; 89:1603-10. [DOI: 10.1016/j.athoracsur.2010.02.037] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 02/10/2010] [Accepted: 02/12/2010] [Indexed: 11/29/2022]
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49
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Kosan B, Steger V, Walker T, Friedel G, Aebert H. Surgery of pulmonary aspergillomas in immunocompromised patients. THORACIC SURGICAL SCIENCE 2010; 7:Doc01. [PMID: 21289887 PMCID: PMC3010893 DOI: 10.3205/tss000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Pulmonary aspergillosis is a devastating complication in immunocompromised patients. Timing of surgery is controversial and depends on the patients' general condition. Methods: From 2000 to 2007, 16 patients (mean age 47 years, range 20–64) underwent surgery for pulmonary aspergillosis. All patients were receiving immunosuppressive drugs due to chemotherapy of hematological malignancies, ten with additional bone marrow or stem cell transplantation. Perioperatively, aspergillosis was treated with antifungal agents. If granulocyte numbers in the peripheral blood was below 1.0x109/l, granulocyte stimulating factor and granulocyte transfusions were administered perioperatively. Results: Four patients underwent lobectomy and wedge resections of the same lung, one patient bilobectomy, two patients lobectomy, eight patients wedge resections of one lung, and one patient wedge resections of both lungs. All patients survived surgery without major complications. Five patients were bone marrow or stem cell transplanted 1, 2, 3, 7 and 10 months after surgery. Three of them died due to recurrence of the underlying malignancy. All other patients are alive and free of fungal disease. Conclusions: Timing of surgery in the context of antifungal therapy and adequate numbers of granulocytes and platelets in the peripheral blood appear essential for successful surgical therapy and avoidance of major complications.
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Affiliation(s)
- B Kosan
- Department of Thoracic Surgery, Schillerhoehe Hospital, Gerlingen, Germany
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Pulmonary aspergilloma: Analysis of prognosis in relation to symptoms and treatment. J Thorac Cardiovasc Surg 2009; 138:820-5. [DOI: 10.1016/j.jtcvs.2009.01.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 12/10/2008] [Accepted: 01/24/2009] [Indexed: 11/20/2022]
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