Pulmonary Aspergilloma: About 167 Cases

Abstract

Pulmonary aspergilloma is a serious deep mycosis, especially in countries with high tuberculosis endemicity, because of its bleeding complications, which are sometimes massive, and can be life threatening. Our work is a retrospective, descriptive and analytical study of 167 cases of pulmonary aspergilloma, collected from January 2003 to May 2021 in the department of respiratory diseases of the CHU IBN ROCHD of Casablanca, whose aim was to provide a better characterization of this pathology in our context in order to improve the management of these patients. We counted 111 (66.26%) men and 56 (33.53%) women, aged between 21 and 80 years, with an average age of 48.5 years. A history of tuberculosis was present in 150(89.8%) cases, as well as COPD in 25(15%) cases. Respiratory symptoms were dominated by hemoptysis in 151 (90.4%) cases, dyspnea in 83 (49.7%) cases and chest pain in 55 (33%) cases. 64 (38.32%) cases had a normal pleuropulmonary examination, while 79 (47.3%) cases had snoring. The diagnosis was made mainly on radio-clinical data. Aspergillus serology was positive in 98(59%) cases. On thoracic CT, the typical grelot image was present in 70 (42%) cases. The lesions were predominantly in the right upper lobe in 115(69%) cases. The CT scan also classified the lesions as simple aspergilloma (SCA) in 35(21%) cases and as chronic cavitary pulmonary aspergillosis (CCPA) in 132(79%) cases. The treatment was surgical in 108 (64,67%) cases. The postoperative course was simple in the majority of patients. However, we had 3 (2.77%) postoperative deaths. The average duration of follow-up of these patients was 3.5 years, during which an empyema was noted in 6 (6.81%) cases, a death in 5 (6%) cases and a recurrence in 2 (2.22%) cases. Medical treatment of PA with Itraconazole was indicated in 59 (35%) cases, for an average duration of 12 months with quarterly clinical, biological and radiological follow-up. The evolution was marked by clinical improvement in 15(25%) ....