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Watanabe T, Hirama T, Onodera K, Notsuda H, Oishi H, Niikawa H, Imaizumi K, Okada Y. Native-lung complications following single-lung transplantation for interstitial lung disease: an in-depth analysis. BMC Pulm Med 2024; 24:202. [PMID: 38658879 PMCID: PMC11044553 DOI: 10.1186/s12890-024-03009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) represents a heterogeneous group of lung disorders characterized by fibrotic lung tissue changes. In regions with severe donor shortages, single-lung transplantation (SLTx) is often preferred over bilateral lung transplantation for advanced ILD. However, temporal changes and complications in the retained native lung remain poorly understood. METHODS A retrospective analysis of 149 recipients who had undergone SLTx was conducted, including 34 ILD SLTx recipients. Native-lung volume, radiological alterations, and perfusion were assessed at distinct post-SLTx time points. Statistical analyses compared ILD and non-ILD SLTx groups. RESULTS Our study revealed a progressive reduction in native-lung volume over time, accompanied by radiographic deterioration and declining perfusion. Complications in the retained native lung were observed, such as pneumothorax (29.4%), pulmonary aspergillosis (11.8%), and acute exacerbation (8.9%). Long-term survival rates were similar between ILD and non-ILD SLTx recipients. CONCLUSIONS This study illuminates the unique challenges and complications with respect to the native lung following SLTx for ILD. Ongoing monitoring and tailored management are essential. Despite limitations, this research contributes to our understanding of the temporal progression of native-lung complications post-SLTx for ILD, underscoring the need for further investigation.
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Affiliation(s)
- Toshikazu Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Takashi Hirama
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.
- Division of Organ Transplantation, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Ken Onodera
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Hirotsugu Notsuda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Hisashi Oishi
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Hiromichi Niikawa
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
- Division of Organ Transplantation, Tohoku University Hospital, Sendai, Miyagi, Japan
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Dumoulin E, Thornton CS. Endoscopic Removal of Pulmonary Aspergilloma in a Nonsurgical Candidate. Ann Am Thorac Soc 2023; 20:1516-1520. [PMID: 37772939 DOI: 10.1513/annalsats.202303-218cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/27/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
| | - Christina S Thornton
- Department of Medicine and
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Wang B, Yao L, Sheng J, Liu X, Jiang Y, Shen L, Xu F, Liu Q, Gao C, Dai X. Feasibility and safety of uniportal thoracoscopy for chronic pulmonary aspergillosis. Sci Rep 2023; 13:16480. [PMID: 37777661 PMCID: PMC10542798 DOI: 10.1038/s41598-023-43781-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/28/2023] [Indexed: 10/02/2023] Open
Abstract
Surgery plays a crucial role in the treatment of patients with chronic pulmonary aspergillosis (CPA). However, there is currently limited information available regarding the use of uniportal thoracoscopy (Uni-VATS) in CPA patients. To address this gap, we conducted a retrospective analysis of surgical procedures performed at a single center, aiming to demonstrate the feasibility and safety of Uni-VATS for patients with CPA. We collected basic information and surgical data from patients who underwent surgery for CPA at our hospital between January 2018 and June 2022. All patients received voriconazole antifungal medication for 3-6 months post-surgery and were monitored for a minimum of 6 months. A total of 110 patients, comprising 59 cases in the traditional open chest incision group and 51 cases in the Uni-VATS group, met the inclusion criteria. Among those who underwent surgery, 70% were male (77/110). The median age (IQR) of all enrolled patients was 55 (46-62) years. There were no statistically significant differences in general information, such as age, sex, comorbidities, BMI, FEV1, FVC, clinical symptoms, location of the disease, and duration of voriconazole antifungal medication, between the OS group and the Uni-VATS group (p > 0.05). The postoperative complication rates were 40.7% (24/59) for the traditional open chest incision group and 17.6% (9/51) for the Uni-VATS group. Through univariate analysis, we identified sex and operative approach as risk factors for postoperative complications. Multivariate logistic analysis confirmed that male and OS procedures were the independent risk factors for postoperative complications. There were statistically significant differences in operative time, intraoperative blood loss volume, postoperative drainage volume, pain scores, postoperative drainage tube removal time, postoperative hospital stay time between the OS group and the Uni-VATS group (p < 0.05). Uni-VATS is a feasible and safe surgical procedure for patients with CPA, and we recommend it as a preferred option for selected patients with CPA.
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Affiliation(s)
- Bing Wang
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No. 28, Wuhan, Hubei, China
| | - Li Yao
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No. 28, Wuhan, Hubei, China
| | - Jian Sheng
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No. 28, Wuhan, Hubei, China.
| | - Xiaoyu Liu
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No. 28, Wuhan, Hubei, China.
| | - Yuhui Jiang
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No. 28, Wuhan, Hubei, China
| | - Lei Shen
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No. 28, Wuhan, Hubei, China
| | - Feng Xu
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No. 28, Wuhan, Hubei, China
| | - Qibin Liu
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No. 28, Wuhan, Hubei, China
| | - Chao Gao
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No. 28, Wuhan, Hubei, China
| | - Xiyong Dai
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No. 28, Wuhan, Hubei, China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Arai H, Tajiri M, Kikunishi N, Nakamura S, Inafuku K, Sekine A, Okudela K, Iwasawa T, Masuda M. Fungus ball removal with video-cavernoscopy for complex aspergilloma. Gen Thorac Cardiovasc Surg 2021; 69:1400-1406. [PMID: 33969467 DOI: 10.1007/s11748-021-01645-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Complete resection with a clear margin is the only curative treatment for pulmonary aspergilloma. This requires a high-level technique, especially for complex aspergilloma (CA), because of patient conditions and wide dense adhesions. Fungus ball removal is used palliatively to control hemoptysis, rather than as a radical procedure, and may be performed using video-cavernoscopy as a simple and repeatable method. In this study, we examined this approach as an alternative treatment for CA. METHODS Eight cases of fungus ball removal with video-cavernoscopy (video-cavernoscopic removal) treated at our center were retrospectively reviewed. The patient characteristics and surgical outcomes were compared with those of patients treated with one-stage radical surgery. RESULTS There were 8 subjects (7 males, 1 female; median age 65 years) in the video-cavernoscopic removal group and 25 subjects (19 males, 6 females; median age 56 years) in the one-stage radical surgery group. The video-cavernoscopic removal group had a higher rate of emphysematous lung (p = 0.001), a lower body mass index (p = 0.039), and a lower percent vital capacity (p = 0.027). All cases in this group had preoperative hemoptysis that ceased after the procedure. Video-cavernoscopic removal was less invasive based on a shorter operative time (p = 0.000), less blood loss (p = 0.002), and a lower Common Terminology Criteria for Adverse Events grade (p = 0.023). However, four cases in this group (50%) relapsed with a median disease-free survival period of 471.5 days. CONCLUSIONS Fungus ball removal with video-cavernoscopy is a simple technique for the prevention and control of massive hemoptysis that may be an alternative treatment for CA.
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Affiliation(s)
- Hiromasa Arai
- Department of General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, 236-8651, Japan.
| | - Michihiko Tajiri
- Department of General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, 236-8651, Japan
| | - Noritake Kikunishi
- Department of General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, 236-8651, Japan
| | - Sho Nakamura
- Department of General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, 236-8651, Japan
| | - Kenji Inafuku
- Department of General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, 236-8651, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, 236-8651, Japan
| | - Koji Okudela
- Department of Pathology, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, 236-8651, Japan
| | - Munetaka Masuda
- Departoment of Surgery, Yokohoma City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Crehuet Gramatyka D, Cortés Sáez J, Gómez-Chacón Villalba J, Marco Macián A, Mínguez Gómez A, Miró Rubio I, Costa Roig A, Del Peral Samaniego M, Vila Carbó JJ. Surgical treatment of pulmonary aspergilloma in pediatric patients: report of 3 cases. Cir Pediatr 2020; 33:193-199. [PMID: 33016660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To describe our experience in the surgical management of pulmonary aspergilloma (PA) and review surgery's role in PA treatment in pediatric patients. MATERIAL AND METHODS A descriptive study of patients diagnosed with PA undergoing surgical resection from 2017 to 2019 was carried out. A review of pediatric studies mentioning "aspergilloma", "surgical", and "treatment" was performed. RESULTS During the study period, 3 patients with single PA aged 18 months old, 3 years old, and 13 years old underwent surgery. All of them had leukemia and little or no response to aspergilloma medical treatment. In all patients, the procedure was initiated using the thoracoscopic route, but conversion into thoracotomy was required in two cases. In all three cases, pulmonary segmentectomy was carried out with complete PA removal, without severe intraoperative or postoperative complications. No pulmonary recurrence was observed after 30-, 34-, and 16-month follow-up, respectively. CONCLUSIONS PA surgical resection is a feasible alternative in pediatric patients with a poor antifungal treatment response or related complications.
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Affiliation(s)
- D Crehuet Gramatyka
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital, Valencia (Spain)
| | - J Cortés Sáez
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital, Valencia (Spain)
| | | | - A Marco Macián
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital, Valencia (Spain)
| | - A Mínguez Gómez
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital, Valencia (Spain)
| | - I Miró Rubio
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital, Valencia (Spain)
| | - A Costa Roig
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital, Valencia (Spain)
| | - M Del Peral Samaniego
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital, Valencia (Spain)
| | - J J Vila Carbó
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital, Valencia (Spain)
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Cho H, Kim G, Song S, Yoo J, Kim M, Chung J, Kim S, Park S. Detection of anatomical variation during left internal jugular vein cannulation under ultrasound: A case report. Medicine (Baltimore) 2020; 99:e21129. [PMID: 32629747 PMCID: PMC7337579 DOI: 10.1097/md.0000000000021129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The left internal jugular vein has a higher possibility of anatomical variation than the right side. Therefore, the complication risk during cannulation is expected to be higher. PATIENT CONCERNS A 74-year-old woman was scheduled for elective surgery for left upper lobe wedge resection. We observed an anatomical abnormality at the location of the common carotid artery (CCA) and left internal jugular vein (IJV). DIAGNOSIS During the ultrasound, the left IJV was detected at the medial side of the CCA, and this anatomical variation was confirmed by color Doppler ultrasonography. Enhanced chest computed tomography showed that the left CCA ran across the left IJV from medial to lateral at the level of the clavicle. INTERVENTION A triple-lumen central venous catheter was inserted at the right IJV to avoid complications caused by the anatomical variation. OUTCOMES There were no intraoperative or postoperative complications. LESSONS Anesthesiologists should consider anatomical variation during central venous cannulation, especially with the left IJV approach. Because of anatomical variation, ultrasound-guided intervention is highly recommended to prevent procedure-related complications.
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Abstract
Pulmonary aspergilloma is a form of aspergillosis characterized by the colonization of a preexisting pulmonary cavity, most often of tuberculosis origin. Clinical symptoms are predominately hemoptysis that can be life-threatening, and thoracic computed tomography can distinguish simple from complex pulmonary aspergilloma. The best therapeutic option remains surgery which allows surgical resection of the mycetoma and the underlying cavity. Nonsurgical treatment is performed in inoperable patients because of severe respiratory failure or a poor general condition.
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Affiliation(s)
| | - Rabiou Sani
- Faculty of Medicine, Abdou Moumouni University, Niamey, Niger
| | | | - Marouane Lakranbi
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Yassine Ouadnouni
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Mohamed Smahi
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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Singh H, Kumar V, Katti M, Khanna S. Physiological Lung Exclusion in Tetralogy of Fallot Without Left Pulmonary Artery With Aspergilloma. Ann Thorac Surg 2019; 109:e293-e295. [PMID: 31518581 DOI: 10.1016/j.athoracsur.2019.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 11/18/2022]
Abstract
Tetralogy of Fallot with unilateral absence of the pulmonary artery is a rare congenital cardiac disorder that makes the ipsilateral lung susceptible to opportunistic infections. This disorder adds to the complexity of the case and tests the surgical and decision-making skills of the surgeon. We present an adult male patient with tetralogy of Fallot and absent left pulmonary artery who underwent physiologic exclusion of the left lung for aspergilloma along with intracardiac repair as a single stage procedure.
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Affiliation(s)
- Harkant Singh
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Kumar
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Madhusudan Katti
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudhansoo Khanna
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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AlShanafey S, AlMoosa N, Hussain B, AlHindi H. Surgical management of pulmonary aspergillosis in pediatric population. J Pediatr Surg 2019; 54:1938-1940. [PMID: 30755326 DOI: 10.1016/j.jpedsurg.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Aspergillosis is an invasive infection that affects mainly immunocompromised patients, and the lung is the most common site of infection. We reviewed our experience with the surgical management of pulmonary aspergillosis (PA) in pediatric population at a tertiary care institution. METHODS A retrospective chart review was conducted for pediatric patients (<16 years) who were managed for PA over the period from January 2001 to December 2016. Demographic, clinical, and outcome data were retrieved, and descriptive data were generated. RESULTS Eighty patients had microbiologically-proven PA over the period of the study, and 38 of them (48%) had a surgical intervention during their management. Among the surgical group, there were 19 males and 19 females with a mean age of 9.4 years (0.5-16). Thirty-five patients (92%) were in an immunocompromised state (10 of them have had bone marrow transplant), 2 patients had cystic lung disease, and 1 had scleroderma. All had fever and respiratory symptoms at presentation and received systemic antifungal medications. All had Computerized tomography (CT) scan examinations which showed features suggestive of the disease. Surgical procedures included lung biopsy in 13 patients (34%), segmentectomy in 12 patients (32%), lobectomy in 8 patients (21%), debridement/cavernostomy in 3 patients (8%), and 2 patients had pneumonectomy (5%). Histopathological examination revealed invasive fungal infection in 20 patients (53%) and aspergilloma in 18 (47%). Eleven patients (29%) died owing to a combination of fungal infection and the underlying disease. Three other patients, not included in the surgical series, died secondary to severe pulmonary hemorrhage while waiting for surgery. All had cavitation on CT scan near the hilum of the lung. CONCLUSIONS Pulmonary aspergillosis is a severe invasive infection with a significant mortality. Early surgical intervention is recommended in patients who do not improve on antifungal medication, especially in those with cavitating lesions, in order to improve outcome. TYPE OF STUDY Case series. LEVEL OF EVIDENCE IV.
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Uehara Y, Kasai H, Nakajima T, Tanabe N, Tatsumi K, Yoshino I. Aspergillus Sternomyelitis Developed from Chronic Pulmonary Aspergillosis as a Late Complication to Lobectomy for Lung Cancer. Intern Med 2018; 57:2991-2994. [PMID: 29877261 PMCID: PMC6232016 DOI: 10.2169/internalmedicine.0334-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Progressive fibrobullous changes in the residual lobes are sometimes observed after lobectomy. Aspergillus osteomyelitis is an uncommon infection that rarely occurs sternally. A 70-year-old man who had undergone lobectomy 12 years earlier was admitted to our hospital for chest pain. He was diagnosed with Aspergillus sternomyelitis based on sternal bone culture after an ultrasound-guided percutaneous needle biopsy. The fibrosis and right residual lung apex volume loss had gradually progressed over 12 years, and therefore, chronic pulmonary aspergillosis (CPA) with direct invasion sternal from the CPA was considered. Aspergillus sternomyelitis can develop from CPA as a late complication of lobectomy.
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Affiliation(s)
- Yuji Uehara
- Department of Medicine, School of Medicine, Chiba University, Japan
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Takahiro Nakajima
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Nobuhiro Tanabe
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Japan
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Zhan M, Xu B, Zhao L, Li B, Xu L, Sun Q, Zhang J, Zhang Z, Chu H. The Serum Level of IL-1B Correlates with the Activity of Chronic Pulmonary Aspergillosis. Can Respir J 2018; 2018:8740491. [PMID: 30363691 PMCID: PMC6180967 DOI: 10.1155/2018/8740491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/26/2018] [Accepted: 09/02/2018] [Indexed: 12/21/2022] Open
Abstract
Background Until now, there have been no objective criteria to determine the activity of chronic pulmonary aspergillosis (CPA). This study aims to analyze the correlation between serum level of IL-1B and the activity of CPA and to determine whether serum IL-1B could be used to assess the activity of CPA. Methods A total of 469 newly diagnosed CPA patients were enrolled. Correlation analysis in the whole subjects showed that only IL-1B level was associated with the activity of CPA. Then, 381 cases with factors significantly affecting IL-1B expression was excluded through multiple linear regression; the remaining 88 patients were divided into high IL-1B group and low IL-1B group, according to the median value of serum IL-1B, for subgroup analysis. A retrospective comparative analysis was subsequently performed between the two groups, including the clinical manifestation, microbiology and laboratory tests results, and imaging findings. We further investigated the relationship between IL-1B levels and CT characteristic which acted as the indicator of CPA activity, as well as changes in IL-1B level before and after surgery. Results For all patients, correlation analysis revealed that IL-1B level correlated with both cavitary diameter (P=0.035) and aspergilloma size (P<0.047) but not with the thickness of the cavity (P=0.479). In subgroup comparative analysis, CT characteristics suggested that high activity of CPA, such as cavitary (27/44 vs 13/44, P=0.003) and aspergilloma lesions (25/44 vs. 11/44, P<0.002), were more frequently found in high IL-1B group. The cavity diameter (P<0.001), aspergilloma size (P=0.006), and cavity wall thickness (P=0.023) were significantly different between the two groups. When Spearman correlation analysis was performed once again in subgroup, an even stronger relationship of serum IL-1B with the cavity diameter (Rs=0.501, P=0.002) and aspergilloma size (Rs=0.615, P=0.001) was observed. Interestingly, a significant reduction of IL-1B level was observed after successful resection of CPA lesions. Conclusion Higher level of serum IL-1B is associated with more severe cavitary and aspergilloma lesions, which are indicative of more active CPA. In addition, IL-1B level reduced accordingly after lesion resection. Measuring IL-1B level therefore could be served as a convenient method to monitor the activity of CPA and be a potential predictive/prognostic marker for treatment response.
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Affiliation(s)
- Mengling Zhan
- Tongji University School of Medicine, Shanghai 200092, China
| | - Benyong Xu
- Tongji University School of Medicine, Shanghai 200092, China
| | - Lan Zhao
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Bing Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Liyun Xu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Qiuhong Sun
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jun Zhang
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Internal Medicine, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Zhemin Zhang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Haiqing Chu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Sakuraba M, Yamasaki H, Kusudo S, Tanaka A. [Assessment of Surgical Treatment for Chronic Pulmonary Aspergillosis]. Kyobu Geka 2018; 71:323-328. [PMID: 29755081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The purpose of this study is to assess retrospectively our treatment strategy for chronic pulmonary aspergillosis(CPA). PATIENTS AND METHOD From 2002 to 2015, 11 patients underwent pulmonary resection for CPA in our hospital. Six patients were diagnosed simple pulmonary aspergilloma (SPA) and 5 were chronic progressive pulmonary aspergillosis(CPPA). Clinical characteristics, preoperative treatment, postoperative treatment, surgical procedure, postoperative complication, recurrence, and prognosis were retrospectively reviewed. RESULTS Two patients of SPA and 5 of CPPA were treated with antifungal agents preoperatively. Two patients required wedge resection and 4 required lobectomy in SPA. Five patients required lobectomy in CPPA. All patients were treated with antifungal agents postoperatively. One patient presented recurrent disease in both SPA and CPPA. All patients has been alive. CONCLUSION Surgical resection of CPA leads good results in selected patients. The treatment with surgery with perioperative antifungal treatment is thought to be important based on our experience.
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Affiliation(s)
- Motoki Sakuraba
- Department of Thoracic Surgery, Sapporo City General Hospital, Sapporo, Japan
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Tokunaga Y, Okamoto T, Chang S. [Lung Adenocarcinoma with Pulmonary Aspergillosis Showing Cavity Disappearance;Report of a Case]. Kyobu Geka 2017; 70:151-154. [PMID: 28174412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 49-year-old man complaining of fever, chest pain, and hemosputum was examined at a local hospital. A chest computed tomography (CT) scan revealed a 35 mm mass shadow with cavity in the right upper lobe, but a transbronchial lung biopsy could not establish a complete diagnosis. After 1 month follow-up, the patient was referred to our hospital because the mass shadow wall remained thick despite the cavity shrinking. The mass shadow cavity disappeared 2 months after the 1st CT at our hospital. Video-assisted thoracic surgery was performed for both making diagnosis and treatment. The patient was diagnosed with non-small cell lung cancer with pulmonary aspergillosis during surgery, and a right upper lobectomy with systematic lymph node dissection was performed. Pathological examinations revealed that the tumor was a T3N0M0 stage II B adenocarcinoma with pulmonary aspergillosis. The patient was treated with adjuvant chemotherapy 4 months after surgery and is under follow-up.
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Affiliation(s)
- Yoshimasa Tokunaga
- Department of General Thoracic Surgery, Kochi Health Sciences Center, Kochi, Japan
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15
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Stather DR, Tremblay A, Dumoulin E, MacEachern P, Chee A, Hergott C, Gelberg J, Gelfand GA, Burrowes P, MacGregor JH, Mody CH. A Series of Transbronchial Removal of Intracavitary Pulmonary Aspergilloma. Ann Thorac Surg 2016; 103:945-950. [PMID: 27765172 DOI: 10.1016/j.athoracsur.2016.08.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 07/18/2016] [Accepted: 08/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intracavitary pulmonary aspergilloma is a chronic, debilitating fungal infection. Without definitive therapy, death can occur from massive hemoptysis, cachexia, or secondary infection. Although surgical resection is the standard therapy, it is not possible for many patients owing to poor pulmonary function or medical comorbidities. Aspergilloma removal through bronchoscopy is an important alternative therapy that may be available in select cases. METHODS We retrospectively reviewed all cases referred to the University of Calgary Interventional Pulmonary Service for transbronchial removal of intracavitary aspergilloma from January 1, 2009, to January 1, 2014. RESULTS Ten patients with intracavitary pulmonary aspergilloma were identified. In 3 patients, the aspergilloma cavity was not accessible by bronchoscopy. Successful removal of the aspergilloma with symptom improvement or resolution was achieved in 6 of 7 cases. One of the patients was lost to follow-up. Minor hypoxia lasting 12 to 72 hours was observed in 5 cases. Severe sepsis requiring an extended critical care unit stay occurred in 1 case. Follow-up ranged from 9 months to 5 years. CONCLUSIONS Although not without risk of minor hypoxia and possible sepsis, for carefully selected patients, bronchoscopic removal of symptomatic intracavitary pulmonary aspergilloma may be an alternative therapy to surgical resection for this life-threatening disease.
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Affiliation(s)
- David R Stather
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alain Tremblay
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Elaine Dumoulin
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Paul MacEachern
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alex Chee
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Jacob Gelberg
- Department Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gary A Gelfand
- Department of Surgery, Immunology and Infectious Disease, University of Calgary, Calgary, Alberta, Canada
| | - Paul Burrowes
- Department of Radiology, Immunology and Infectious Disease, University of Calgary, Calgary, Alberta, Canada
| | - John H MacGregor
- Department of Radiology, Immunology and Infectious Disease, University of Calgary, Calgary, Alberta, Canada
| | - Christopher H Mody
- Department of Microbiology, Immunology and Infectious Disease, University of Calgary, Calgary, Alberta, Canada
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16
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Ashizawa N, Nakamura S, Ide S, Tashiro M, Takazono T, Imamura Y, Miyazaki T, Izumikawa K, Yamamoto Y, Yanagihara K, Miyazaki Y, Kohno S. Successful Treatment of Aspergillus Empyema Using Open Window Thoracostomy Salvage Treatment and the Local Administration of an Antifungal Agent. Intern Med 2016; 55:2093-9. [PMID: 27477422 DOI: 10.2169/internalmedicine.55.6250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 76-year-old woman received long-term immunosuppressive treatment for collagen vascular disease-associated interstitial pneumonia. The patient developed a cavitary mass lesion in the right lower lung field, and both nontuberculous mycobacteria and Aspergillus spp. were isolated after bronchial washing. The patient underwent a right lower lobectomy but developed Aspergillus empyema. Empyema due to Aspergillus spp. is a rare and life-threatening condition; however, the standard therapeutic strategies for treating Aspergillus empyema are not clear. We herein report a case of Aspergillus empyema that was successfully treated with a combination therapy which included open-window thoracostomy and the administration of antifungal agents (systemic micafungin and local amphotericin-B).
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Affiliation(s)
- Nobuyuki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Aydoğdu K, İncekara F, Şahin MF, Gülhan SŞE, Findik G, Taştepe İ, Kaya S. Surgical management of pulmonary aspergilloma: clinical experience with 77 cases. Turk J Med Sci 2015; 45:431-7. [PMID: 26084137 DOI: 10.3906/sag-1401-165] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM This retrospective study evaluated the clinical presentation, underlying lung disease, surgical indications, technique, treatment outcomes, and postoperative complications of pulmonary aspergilloma. MATERIALS AND METHODS We evaluated 77 patients who underwent pulmonary resection of an aspergilloma at Atatürk Chest Diseases and Thoracic Surgery Research and Training Hospital between January 2000 and December 2013. The initial operations were 4 pneumonectomies, 24 lobectomies, 9 lobectomy plus myoplasties, 10 segmental resections, and 30 wedge resections. Six reoperations were carried out to deal with postoperative complications: 1 myoplasty, 2 completion lobectomies plus myoplasties, 2 myoplasties with rib resections, and 1 completion lobectomy. RESULTS The subjects comprised 53 males (mean age: 44.26 (range: 10-73) years) and 24 females (mean age: 48.25 (range: 26-70) years). The most common indication for surgery was hemoptysis in 52 patients (67.53%). The most common underlying lung disease was tuberculosis in 37 patients (48.05%). Forty patients (51.94%) had a simple pulmonary aspergilloma and 37 (48.05%) had a complex pulmonary aspergilloma. Major complications occurred in 18 patients (23.37%). The postoperative mortality rate was 3.89%, with 3 patients dying. CONCLUSION Surgical resection of pulmonary aspergilloma is the best way to prevent recurrent hemoptysis with low morbidity and mortality.
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18
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Billè A, Giovannetti R, Calarco G, Pastorino U. Tailored stent for bronchial stump fistula closure and omentoplasty for infection control: a combined approach with low morbidity. Tumori 2014; 100:157e-9e. [PMID: 25296609 DOI: 10.1700/1636.17938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bronchopleural fistula (BPF) after pneumonectomy remains a dangerous complication with high mortality and morbidity. Primary closure of the fistula with muscle flaps and a thoracic window is generally used to treat BPF. New techniques for secondary stump closure including glues, stents and coils have been introduced recently. We report the use of a J-shaped tracheal stent device placed during bronchoscopy combined with omentoplasty to control the symptoms related to BPF and pleural space infection, respectively.
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19
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Pagès PB, Grima R, Mordant P, Grand B, Badia A, Le Pimpec-Barthes F, Bernard A, Riquet M. [Does antifungal therapy influence postoperative morbidity or long-term survival after surgical resection for pulmonary aspergilloma?]. Rev Pneumol Clin 2014; 70:322-328. [PMID: 25457220 DOI: 10.1016/j.pneumo.2014.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/24/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Surgical resection of pulmonary aspergilloma is associated with symptoms control, complications prevention, and improved survival, given that the disease is localized and the patient fit enough to undergo surgery. In these operable forms, the impact of perioperative antifungal therapy remains controversial. The purpose of this study was to analyze the impact of antifungal therapy on postoperative morbidity and overall survival in patients with operable pulmonary aspergilloma. METHODS The clinical records of 113 patients who underwent thoracic surgery for aspergilloma in our institution from January 1989 to December 2010 were retrospectively reviewed. Of these, 64 patients received antifungal therapy in the perioperative period and were included in group 1, and 49 patients did not receive antifungal therapy and were included in group 2. RESULTS Postoperative complication rates were 31.2% in group 1 and 20.4% in group 2 (P = 0.30). Univariable analysis showed that immunocompromised status (P < 0.001), past history of cancer (P = 0.50), preoperative purulent sputum (P = 0.024), and pneumonectomy (P < 0.001) were significantly associated with postoperative complications, but that antifungal therapy was not. Five- and 10-year overall survival rates were respectively 78.3% and 57.8% in group 1 vs. 85.9% and 65.7% in group 2 (P = 0.23). Multivariate analysis revealed that age higher than 50, immunocompromised status and pneumonectomy were significantly associated with adverse long-term survival (χ(2) = 6.59, df = 5, P < 0.001), but that antifungal therapy was not. CONCLUSION Antifungal therapy has no significant impact on postoperative morbidity or long-term survival following surgical resection of pulmonary aspergilloma. Such procedure is associated with acceptable postoperative morbidity and long-term survival.
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Affiliation(s)
- P-B Pagès
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France; Service de chirurgie thoracique et cardiovasculaire, CHU Bocage, université de Bourgogne, 21000 Dijon, France
| | - R Grima
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - P Mordant
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - B Grand
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - A Badia
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - A Bernard
- Service de chirurgie thoracique et cardiovasculaire, CHU Bocage, université de Bourgogne, 21000 Dijon, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France.
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20
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Abstract
Multidisciplinary management of thoracic infection, including experts in thoracic surgery, pulmonology, infectious disease, and radiology, is ideal for optimal outcomes. Initial assessment of parapneumonic effusion and empyema requires computed tomographic evaluation and consideration for fluid sampling or drainage. Goals for the treatment of parapneumonic effusion and empyema include drainage of the pleural space and complete lung reexpansion. Pulmonary abscess is often successfully treated with antibiotics and observation. Surgical intervention for the treatment of fungal or tuberculous lung disease should be undertaken by experienced surgeons following multidisciplinary assessment. Sternoclavicular joint infection often requires joint resection.
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Affiliation(s)
- Daniel Raymond
- Thoracic & Cardiovascular Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, J4-1, Cleveland, OH 44195, USA.
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Dajer-Fadel WL, Borrego-Borrego R, Argüero-Sánchez R. Aspergilloma in a pneumonectomized cavity. Asian Cardiovasc Thorac Ann 2014; 22:991. [PMID: 24887852 DOI: 10.1177/0218492313495217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Walid Leonardo Dajer-Fadel
- Cardiothoracic Surgery Department, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Rafael Borrego-Borrego
- Cardiothoracic Surgery Department, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Rubén Argüero-Sánchez
- Cardiothoracic Surgery Department, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico
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Yoshida T, Toyokawa G, Takenoyama M, Ichinose Y. Invited commentary. Ann Thorac Surg 2014; 97:223. [PMID: 24384173 DOI: 10.1016/j.athoracsur.2013.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Tsukihisa Yoshida
- Department of Thoracic Oncology, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan
| | - Gouji Toyokawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan
| | - Mitsuhiro Takenoyama
- Department of Thoracic Oncology, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan; Clinical Research Institute, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan
| | - Yukito Ichinose
- Clinical Research Institute, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan.
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23
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Affiliation(s)
- Christian Pohl
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Levan Jugheli
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fredrick Haraka
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
| | - Elirehema Mfinanga
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
| | - Khadija Said
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
| | - Klaus Reither
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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24
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Yabuki H, Tabata T, Sugawara T, Fukaya K, Fujimura S. [Treament using a free omental flap for pulmonary Aspergillosis with chronic methicillin-resistant Staphylococcus aureus( MRSA) empyema after fenestration]. Kyobu Geka 2013; 66:786-790. [PMID: 23917228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A case is 48-year-old man who had a history of Blalock-Taussig shunt and the radical operation for Fallot's tetralogy, had been performed cavernostomy and fenestration operation for aspergilloma of left upper lobe in the previous hospital due to control blood spitting. Although the contents of the abscess cavity were removed, the opened cavity was again infected by methicillin-resistant Staphylococcus aureus (MRSA) and he was referred to our hospital. The plombage of free omental flap with vascular anastomosis was performed. He has been well without any symptoms or recurrence of empyema for 6 years after surgery.
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Affiliation(s)
- Hiroshi Yabuki
- Department of Thoracic Surgery, Tohoku Pharmaceutical University Hospital, Sendai, Japan
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25
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Ruan JZ, Zhang TH, Duan Y, Wang ZT. [Surgical treatment of pulmonary tuberculosis complicated with aspergilloma]. Zhonghua Yi Xue Za Zhi 2013; 93:1975-1977. [PMID: 24169247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the surgical indications of pulmonary tuberculosis complicated with aspergilloma , and to reduce postoperative complications. METHODS From 1993 to 2010, a total of 51 surgically treated patients in pulmonary tuberculosis complicated with aspergilloma were analyzed retrospectively. The common surgical procedure performed was lobectomy(60.8%), followed by segmentectomy(15.7%), pneumonectomy(9.8%), wedge resection(9.8%). RESULTS Postoperative non-fatal complications occurred in all patients, the complications (13 cases) included postoperative atelectasis(7.8%), bleeding(5.9%), bronchopleural fistula(5.9%), cardiac arrhythmia and heart failure(2.0%), incisional infection(2.0%). CONCLUSIONS Surgical treatment of pulmonary tuberculosis complicated with aspergilloma is the most effective treatment; pulmonary resection is the treatment of choice when indicated.
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Affiliation(s)
- Jun-zhong Ruan
- Beijing Chest Hospital, Capital Medical University, Beijing 101149, china
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26
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Jonas C, Eucher P, Gustin T, Donckier JE. Chronic necrotising aspergillosis mimicking ACTH-secreting tumour in a case of Cushing's disease. Acta Clin Belg 2013; 68:143-6. [PMID: 23967728 DOI: 10.2143/acb.3016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An 18-year-old man presenting with speech and behaviour disorders was found to suffer from Cushing's syndrome. Ectopic ACTH secretion was initially suspected on the basis of very high cortisoluria and ACTH concentrations, severe hypokalemia, a lung hypermetabolic lesion and a normal pituitary on conventional magnetic resonance imaging (MRI). After lung surgery, this lesion proved to be chronic necrotising aspergillosis (CNA). Diagnostic reevaluation by bilateral inferior petrosal sinus sampling disclosed a right-sided petrosal sinus gradient consistent with Cushing's disease (CD). A new high resolution thin-section MRI demonstrated a 5 mm pituitary adenoma, which could be removed successfully. Thus, a lung mass associated with several clues in favour of ectopic ACTH secretion may hide a diagnosis of CD. Such a mass can be CNA, an opportunistic infection favoured by immunosuppression, which to our knowledge, is the first case reported in CD.
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Affiliation(s)
- C Jonas
- Department of Internal Medicine-Endocrinology, University Hospital of Mont-Godinne, Université catholique de Louvain, Yvoir, Belgium
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Sindhwani G, Rawat J, Kesarwani V. Haemoptysis after four years of lobectomy for aspergilloma. Indian J Chest Dis Allied Sci 2013; 55:43-44. [PMID: 23798090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We present a case of a 26-year-old male who underwent lobectomy for life-threatening haemoptysis due to aspergilloma in an old tuberculosis left upper lobe cavity who presented with recurrence of haemoptysis four years after the surgery. Fibreoptic bronchoscopy revealed Aspergillus colonisation in the ectatic residual bronchus which is an uncommon complication of lobectomy. The patient was successfully managed with antifungal agents.
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Affiliation(s)
- Girish Sindhwani
- Department of Pulmonary Medicine, Himalayan Institute of Medical Sciences, Dehradun (Uttarakhand), India.
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Pagès PB, Abou Hanna H, Caillot D, Bernard A. [Place of surgery in pulmonary aspergillosis and other pulmonary mycotic infections]. Rev Pneumol Clin 2012; 68:67-76. [PMID: 22425505 DOI: 10.1016/j.pneumo.2012.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2011] [Indexed: 05/31/2023]
Abstract
Surgery is part of the therapeutic strategy of aspergillosis and mucormycosis. The aspergilloma is defined as a rounded mass, developing in a cavity by the proliferation of spores of Aspergillus. The most common complication was haemoptysis reported in 50-95% of cases. The pleuropulmonary lesions predisposing are: tuberculosis, residual pleural space, emphysema and lung destroyed by fibrosis or radiotherapy or bronchiectasis. The indications for surgery depend on symptoms, respiratory function, the parenchyma and the type of aspergilloma (simple or complex). In a patient with an intrapulmonary aspergilloma, lung resection preceded by embolization is recommended based on respiratory function. For intrapleural aspergilloma, thoracoplasty is recommended according to the patient's general condition. The invasive pulmonary aspergillosis (IPA) is characterized by an invasion of lung tissue and blood vessels by hyphae in immunocompromised patients. The death rate of patients who have an API after treatment for leukemia or lymphoma was 30 to 40%, after bone marrow transplantation 60%, after solid organ transplantation from 50 to 60% and after any other cause of immunocompromising from 70 to 85%. The main cause of these deaths is massive hemoptysis. Surgery (lobectomy) is indicated for the prevention of hemoptysis when the mass is in contact with the pulmonary artery or one of its branches, and if it increases in size with the disappearance of border security between the mass and the vessel wall. The patient will be operated in an emergency before the white blood cells do not exceed the threshold of 1000 cells/μl. A persistent residual mass after antifungal treatment may justify a lung resection (lobectomy or wedge) before a new aggressive therapy. Mucormycosis affects patients following immunocompromising states--haematologic malignancy, diabetes mellitus, transplantation, burns and malnutrition. The treatment of pulmonary mucormycosis combines surgical and medical approach.
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Affiliation(s)
- P-B Pagès
- Service de chirurgie thoracique, hôpital du Bocage-Central, CHU de Dijon, 14 rue Gaffarel, Dijon cedex, France
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30
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Bobocea AC, Paleru C, Lovin C, Dănăilă O, Bolca C, Stoica R, Cordoş I. [Videomediastinoscopic transcervical approach of postpneumonectomy left main bronchial fistula]. Pneumologia 2012; 61:44-47. [PMID: 22545489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Bronchopleural fistulas and empyema are the most devastating complications after lung resection. The optimal management remains a major subject of controversy for thoracic surgeons over the wide variety of therapeutic approaches, none suitable for all patients. In 1996 Azorin et al. reported the first successful mediastinoscopic reclosure by stapling of an insufficient bronchial stump after left pneumonectomy using video-assisted mediastinoscopy. The authors report the first national case of left-sided bronchopleural fistula closure using video-assisted mediastinoscopy, describing their experience with this technique. A 40 years old woman presented to our unit with left thorax empyema after having undergone left pneumonectomy for TB destructed lung with aspergillosis in another hospital. Bronchoscopy revealed a 15 mm long bronchial stump with insufficiency. Despite all advances made over the last decades in perioperative management, bronchopleural fistula after pneumonectomy remains a significant problem in thoracic surgery. Video-mediastinoscopy is an alternative to the open methods as it allows approaching the bronchial stump via the mediastinum. The dissection of the trachea through its natural route enables bronchial mobilization. Positive factors influencing our decision were the virgin mediastinum with no surgical dissection and no radiation therapy applied. The mediastinoscopic approach for bronchial stump closure after pneumonectomy is a novel option in highly selected patients. This is our choice for a long (at least 10 mm) bronchial stump because its morbidity is minimal compared with transpericardial sternotomy or a transthoracic approach. It warrants minimal surgical trauma; however, skilled surgeons with experience in mediastinoscopy have to be prepared to convert to an open technique immediately.
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Nakajima Y. [The role and landscape of surgical treatment for mycobacteriosis]. Kekkaku 2011; 86:911-915. [PMID: 22338345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
[Surgery for pulmonary multi-drug resistant (MDR) tuberculosis] For pulmonary MDR tuberculosis the author (me) had been operating many cases in Fukujuji Hospital JATA in fifteen years. For treatment, the points of operations are as follows: 1) Surgery is one of many treatable events, 2) The strategy is that cavitary foci as major sites of tuberculous expectoration have to be removed and other small foci are treated by not strong chemotherapies, 3) Final goal of surgical treatments is set up preoperatively, and its procedures are stepped up gradually. [Surgery for pulmonary non-tuberculous mycobacteriosis (NTM)] Major sites of pulmonary NTM expectorations are cavitary foci and bronchiectases. Main strategy of surgery for pulmonary NTM is the same as MDR tuberculosis, but multi-resections of cavitary and ectatic foci are more than MDR tuberculosis. Control rate of X-ray images is 80%, negative conversion rate is 88.9% in cases with more than one year postoperatively. But new or residual foci will be gradually growing up for several years postoperatively, so many discussions of surgical strategy for NTM are necessary now. [Surgery for pulmonary aspergillosis] Surgical treatments of pulmonary aspergillosis are difficult. Operations for them are mainly two procedures, resection of foci or no resection. The former is more radical than the later, but mortality rate is higher than usual pulmonary resection. However I think chest surgeons have to challenge to remove aspergillous foci, not aspergilloma but chronic necrotizing pulmonary aspergillosis.
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Yokomise H. [Surgical treatment of pulmonary aspergilloma and pulmonary cryptococcosis]. Kyobu Geka 2011; 64:747-751. [PMID: 21916189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Surgical resection of pulmonary aspergilloma contributes not only to controlling severe symptoms but also to the cure for aspergillosis. Early morbidity and mortality that recently reported are acceptable. The operative mode must be selected appropriately according to the status of disease. The prognosis and the postoperative course of accidental surgical resection of pulmonary cryptococcosis are excellent.
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Affiliation(s)
- Hiroyasu Yokomise
- Department of General Thoracic, Breast and Endocrinological Surgery, Kagawa University, Kagawa, Japan
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Endo S. [Emergency resection of the upper right lobe together with the thoracic wall for chronic necrotic pulmonary aspergillosis with sudden development of pulmonary congestion during pneumonectomy]. Kyobu Geka 2011; 64:414. [PMID: 21678661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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34
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Yamaguchi M, Sugio K. [Q & A on diagnostic imaging. A history of pneumothorax and stubborn inflammatory adhesion due to an infectious cyst (found later to be aspergillosis)]. Kyobu Geka 2011; 64:239-243. [PMID: 21595319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Whitley NT, Cauvin A, Burton C, Bray J, Van Dongen P, Littlewood J. Long term survival in two German shepherd dogs with Aspergillus-associated cavitary pulmonary lesions. J Small Anim Pract 2010; 51:561. [PMID: 21029101 DOI: 10.1111/j.1748-5827.2010.00992.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Parău A, Homorodean D, Jodal A, Cristina D. [Respiratory features of Aspergillus infection in eight years of pulmonology practice]. Pneumologia 2010; 59:204-210. [PMID: 21365803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM To evaluate clinical manifestations of Aspergillus infections in our pulmonology practice. METHODS Between 2002-2009, we assessed retrospectively and prospectively, Aspergillus related diseases in patients admitted in Clinical Hospital of Pneumology from Cluj-Napoca, Romania. Positive diagnosis was based on identification of Aspergillus speciae (A spp) on Sabouraud medium, pathological, or immunological proves. RESULTS 83 patients were included. A spp was isolated in 73 patients from: sputum 46, bronchial lavages (BL) 17, both sputum and BL 4, sputum and nasal secretion 1, or from surgical samples 5 cases. In those 10 cases without A spp positive cultures, diagnosis was confirmed by pathologic examination on surgical or bronchoscopical samples in 6 and 2 cases respectively. 76 patients had previous chronic respiratory diseases and 7 had nonrespiratory chronic diseases. We identified the following clinical forms: chronic cavitary aspergillosis 46 cases, aspergillus tracheobronchitis 19 cases, allergic aspergillosis 15 cases, invasive aspergillosis 3 cases. We observed a poor definition on nosological forms, diagnosis like "pulmonary aspergillosis" or "aspergilloma" were the most common. In 12 cases no clinical significance was attributed for detection A spp in bronchial smears. 60 patients supported specific management: antifungal therapy in 38 cases, surgical procedures in 14 cases and both methods in 8 cases, with many differences in treatment and follow-up. CONCLUSIONS Chronic cavitary aspergillosis was the most frequent clinical form observed in our pulmonology practice. Using the clinical guidelines for fungal respiratory infections we can avoid the wrong diagnosis and then include a correct antifungal treatment in the complex management of our chronic pulmonary patients.
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Affiliation(s)
- Adriana Parău
- Spitalul Clinic de Pneumoftiziologie Leon Daniello Cluj-Napoca.
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Savu C, Petreanu C, Cadar G, Matache R, Galie N. [Pulmonary vein anomaly in a patient with pulmonary aspergillosis]. Chirurgia (Bucur) 2010; 105:275-278. [PMID: 20540246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Vein pulmonary anomalies are seldom met. They have a prevalence of 0.4-0.7% of the cases (according to the American authors). The case under discussion is a 68-year-old patient, who was admitted in the hospital for hemoptysis in low quantity but recurrent, physical asteny, fever and weight loss. The onset had been two months before admission to the hospital. The thoracic X-ray shows opacity at the left apex with marked subcostal and costal intensity, with a homogenous area of 5/6 cm. The thoracic CT exam shows multiple bilateral fibronodular images and the left upper lobe shows a cavitary image with regular and thin walls; intracavitary there is an oval formation with mixed densities of approximate 3.5/4/4.5 cm, which suggests a lung aspergilloma. Surgery will be performed--left upper lobectomy associated with atypical resection from the left Fowler segment. During the surgery it is noticed that the left upper pulmonary vein is abnormaly in the left pulmonary hilum. It has a cranial trajectory, runs in parallel with the left phrenic nerve on the mediastinal surface of the left upper lobe then goes in the mediastinum and pours into the left vein branchocefalic trunk. The post-surgery recovery was slowly favourable with complete pulmonary re-expansion, but with the persistence of the aerial losses which imposed pleural drainage for a period of over 2 weeks.
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Affiliation(s)
- C Savu
- Clinica de Chirurgie Toracică, Institutul de Pneumologie Marius Nasta, Bucureşti, România.
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Tran NT, Nguyen TP, Homasson JP. [Aspergillus niger responsible for a tracheo-oesophageal fistula in an immunocompetent patient]. Rev Pneumol Clin 2009; 65:297-299. [PMID: 19878804 DOI: 10.1016/j.pneumo.2009.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 01/18/2009] [Accepted: 03/06/2009] [Indexed: 05/28/2023]
Abstract
Tracheal or bronchial aspergillar locations are rare. They are mainly found in patients with general or localised immune deficiency. The authors report the case of a 53-year-old Vietnamese immunocompetent patient without any factors of risk who suddenly came down with a perforation syndrome indicating a tracheo-oesophageal fistula. The bronchial samples helped identify Aspergillus niger as the agent incriminated. Surgical treatment associated with an antifungal treatment provided a cure without any recurrence for 3 years.
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Affiliation(s)
- N T Tran
- Hôpital Pham Ngoc Thach, 120, Hung Vuong, Ho Chi Minh Ville, Viet Nam.
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40
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Yoneshima Y, Izumi S, Nomura T, Ito H, Morita T, Kudo K. [Three cases of pulmonary aspergilloma treated by cavernostomy and simultaneous removal of fungus balls]. Nihon Kokyuki Gakkai Zasshi 2009; 47:930-936. [PMID: 19882918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report 3 cases of pulmonary aspergilloma treated by cavernostomy and simultaneous removal of fungus balls to eliminate their symptoms. They presented with hemoptysis and prolonged fever with cavitary lesions in their lungs. It was difficult to perform pulmonary resection for them, because of their high age, low respiratory function, and poornutrition. Treatment with anti-fungal agents, obtained no marked effects and thier symptoms were unchanged. Therefore we carried out cavernostomy and simultaneous removal of fungus balls for symptom management. After the surgical treatment, not only did their symptoms improve, but also we were able to maintain good symptom control for a long time. The burden of the surgery on the patients was light and no complications ensued. We strongly believe that cavernostomy and removal of the fungus ball is one of the useful treatment strategies for the patients with pulmonary aspergilloma who are high risks for pulmonary resection and/or who are poorly controlled with anti-fungal chemotherapy.
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Affiliation(s)
- Yasuto Yoneshima
- Department of Respiratory Medicine, International Medical Center of Japan
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Motohashi K, Ito S, Hagihara M, Sakai R, Tanaka M, Kawano T, Maruta A, Ishigatsubo Y, Kanamori H. Allogeneic hematopoietic stem cell transplantation after surgical resection of pulmonary aspergillosis in 5 patients with acute leukemia. Rinsho Ketsueki 2009; 50:430-434. [PMID: 19483405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report five patients with acute leukemia who underwent allogeneic hematopoietic stem cell transplantation (HSCT) following surgical resection of pulmonary aspergillosis. The patients were three men and two women with a median age of 40 (range, 32 approximately 60). The diagnosis, based on CT imaging, Aspergillus antigen, culture, and histopathology of resected lung specimens, included two proven and three possible pulmonary aspergillosis. Median duration from surgery to HSCT was 2.5 months (range, 1.0 approximately 20). Pre-transplant restrictive-type lung dysfunction was observed in four patients. Antifungal prophylaxis after HSCT was attempted with voriconazole in three patients, amphotericin-B in one patient, and micafungin in one patient. No patients experienced a relapse of pulmonary aspergillosis, although three patients died after HSCT. The causes of death included leukemia relapse in two and hemophagocytic syndrome in one. These results suggest that pre-transplant surgical resection with post-transplant prophylactic antifungal agents seems to be an effective strategy to prevent the relapse of pulmonary aspergillosis in patients with residual disease in the lung before allogeneic HSCT.
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Tew CW, Han FC, Jureen R, Tey BH. Aspergillus vertebral osteomyelitis and epidural abscess. Singapore Med J 2009; 50:e151-e154. [PMID: 19421672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present the first reported case of Aspergillus vertebral osteomyelitis and epidural abscess in Singapore in a 50-year-old man with post-tuberculous bronchiectasis. The patient presented with acute urinary retention and flaccid paraplegia. Despite surgical debridement and treatment with voriconazole, the patient developed multiorgan failure and died two weeks after presentation. Early diagnosis and prompt initiation of treatment are emphasised in the hope of improving the outcome of this aggressive condition.
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Affiliation(s)
- C W Tew
- Department of General Medicine, Alexandra Hospital, 378 Alexandra Road, Singapore.
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43
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Ni ZY, Xu J, Zhou M, Cao F. [Clinical analysis of 40 cases of pulmonary aspergilloma]. Zhonghua Jie He He Hu Xi Za Zhi 2008; 31:675-677. [PMID: 19080568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To describe the treatment and diagnosis of pulmonary aspergilloma. METHODS The clinical data of 40 cases of pulmonary aspergilloma were analyzed. RESULTS There were 24 men and 16 women, aged 16-61 years. There were 37 cases with pulmonary tuberculosis with cavity or bronchiectasis Hemoptysis, cough, fever and sweat were present in 33, 5, and 3 cases respectively. The discontinuity repeatedly haemoptysis with a little (< 20 ml/time) were 27 cases. A correct diagnosis of aspergilloma was made in 60% cases (n = 24) before surgery. Lobectomy was performed in 39 cases, and unilateral lung removal in 1 case. Following surgery, 39 cases were cured, and 1 case died. CONCLUSION Pulmonary aspergilloma occurs mostly in middle-aged patients with cavitary or bronchiectatic pulmonary tuberculosis. Misdiagnosis of both the underlying tuberculosis and aspergilloma was common before surgery. Surgery is indicated for patients with heavy hemoptysis, but the value of antifungal therapy needs further studies.
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Affiliation(s)
- Zheng-yi Ni
- Wuhan Tuberculosis Hospital, Wuhan 430083, China
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Guerra M, Santos N, Miranda J, Carlos Mota J, Leal F, Vouga L. [Surgical management of pulmonary aspergilloma]. Rev Port Cir Cardiotorac Vasc 2008; 15:135-138. [PMID: 19116677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
After formation of fungus ball in pre-existing cavities, antifungal agents are very hard to control the infection. Surgical resection offers the only realistic chance of a permanent cure for aspergilloma. However, surgical indications are still a controversy because of the high incidence of postoperative complications. The purpose of this study was to evaluate our indications and results in the surgical treatment of aspergilloma, focusing attention on the postoperative complications and risk factors. From 1990 to 2004, 60 patients with mean age of 44.6 (range, 20-69) were submitted to pulmonary surgery for excision of aspergilloma. Forty-one patients (68.3%) were male, 25 patients (41.7%) were smokers and 47 (78.3%) had tuberculosis as the underlying lung disease. The most frequent indication for surgery was haemoptysis (88.3%). The cavities were mainly situated in the upper lobes (85.0%) and in the right lung (68.3%). Approximately half of aspergillomas (56.7%) were classified as complex aspergillomas. The procedures performed were : 7 pneumectomies (11.7%), 3 bilobectomies (5.0%), 42 lobectomies (70.0%), 7 wedge resections (11.7%) and one cavernostomy (1.7%). There were 3 postoperative deaths (5%), and major complications occurred in 16.3% of the patients including: bleeding (n=3) and bronchopleural fistula (n=2). Recurrence rate was 3.3%. Surgical resection of pulmonary aspergilloma is effective in preventing recurrence of hemoptysis. Preoperative preparation of the patient, meticulous surgical technique, asn postoperative care reduced the rate of complications. We recommend early surgical resection of symptomatic cases with reasonable complications.
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Affiliation(s)
- Miguel Guerra
- Serviço de Cirurgia Cardiotorácica do Centro Hospitalar de Vila Nova de Gaia, Espinho
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Liu JF, Xu B. [Diagnosis and treatment of pulmonary aspergillosis in patients without immunodeficiency: report of 15 cases]. Zhonghua Jie He He Hu Xi Za Zhi 2008; 31:517-519. [PMID: 19035232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To study the diagnosis and treatment of pulmonary aspergillosis in patients without immunodeficiency. METHOD Pulmonary aspergillosis in 15 patients without immunodeficiency was reviewed. RESULTS Twelve of the patients had underlying lung diseases (lung cancer), 2 showed masses in the lung by radiography and CT halo, and 1 had aspergilloma within the left main bronchus. The diagnosis of intra-cavitary aspergilloma had been made in all the patients with lung cancer before surgery. Only 3 cases were confirmed by fungal examination before surgery. Thirteen patients received surgical removal of the lesions, and the post-operative recovery was uneventful. Antifungal therapy and open drainage were administered in 1 patient with pleural residual cavity infection, but the treatment failed. Anti-cancer therapy alone was given in 1 patient. Sudden death occurred in another patient. CONCLUSION In suspected cases of aspergillosis, CT halo sign, histology examination are helpful for the diagnosis. Aspergilloma complicated with underlying lung diseases and mass lesions can be cured by surgery.
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Affiliation(s)
- Ji-Fu Liu
- Department of Thoracic Surgery, General Hospital of Beijing Unite PLA, Beijing 100700, China
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