Clinical Characteristics and Treatment Outcomes of Pathologically Confirmed Aspergillus Nodules.

Noeul Kang,Byung Woo Jhun,Jiyeon Park

doi:10.3390/jcm9072185

Noeul Kang, Byung Woo Jhun + Show 1 more

Open Access

https://doi.org/10.3390/jcm9072185

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Abstract

Aspergillus nodules represent a subtype of chronic pulmonary aspergillosis, but details on their characteristics and outcomes are limited. We evaluated 80 patients with pathologically confirmed Aspergillus nodules between January 2009 and December 2016. The median age of the patients was 59 years, and 46 (58%) were women. Seventy-three (91%) patients were surgically diagnosed with Aspergillus nodules and the remaining seven (9%) patients were diagnosed by percutaneous transthoracic needle biopsy. The median long-axis diameter of nodules was 22 mm, and nodules had an internal cavity in 49 (61%) patients. Spiculation and calcification were observed in 20% and 39% of patients, respectively. Ninety percent (18/20) of nodules showed uptake on positron emission tomography. Serum Aspergillus precipitin IgG antibody was positive in 42% (10/24) of tested patients. Seventy-three (91%) patients underwent surgery without (n = 58) or with (n = 15) adjuvant antifungal therapy, and the remaining seven (9%) patients received antifungal therapy alone (n = 5) or no treatment (n = 2). Three patients experienced postoperative pulmonary complications: pneumothorax, hemoptysis, and acute lung injury (n = 1 each). There was no recurrence during the median follow-up period of 36.8 months. In conclusion, surgery could be a treatment strategy worth considering for most Aspergillus nodules. However, given that our study population was heterogeneous, further well-designed studies are need.

Highlights

Chronic pulmonary aspergillosis (CPA) is a slowly progressing pulmonary infection caused by Aspergillus species, typically Aspergillus fumigatus [1,2]
Aspergillus nodules represent an uncommon subtype of CPA with single or multiple nodular lesions, with or without cavitation, most of which are smaller than 3 cm [1]
Aspergillus nodules represent an uncommon subtype of CPA and are a clinical problem because they often mimic other diseases, such as malignancy or inflammatory nodules [1,9,10]

Summary

Introduction

Chronic pulmonary aspergillosis (CPA) is a slowly progressing pulmonary infection caused by Aspergillus species, typically Aspergillus fumigatus [1,2]. In recent European guidelines, CPA was divided into several phenotypes: simple aspergilloma/nodules, chronic cavitary or fibrosing pulmonary aspergillosis, and a subacute invasive form [1]. Aspergillus nodules represent an uncommon subtype of CPA with single or multiple nodular lesions, with or without cavitation, most of which are smaller than 3 cm [1]. The clinical and radiological manifestations of Aspergillus nodules are nonspecific, and this form of Aspergillus infection is challenging to differentiate from other pulmonary diseases in nodular form, especially lung cancer [8,9]. There is a lack of data regarding the prognosis of Aspergillus nodules

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