Surgical treatment of pulmonary aspergilloma: a single-center experience

Abstract

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 for which patients seek medical attention. 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 intrapleural adhesions, obliteration of the interlobar fissures, massive hemorrhage during dissection, and poor pulmonary reserve of the patient due to the underlying disease. 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 & SSKM Hospital, Kolkata. There were 15 male (62.5 %) and 9 female (37.5 %) patients in this series. 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 %). The mean duration from first diagnosis of tuberculosis to the diagnosis of aspergilloma was 3.4 years. 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 delineating the location of the pulmonary cavity along with the aspergilloma inside it and the characteristic air crescent sign. Right upper lobe was involved in 13 patients (54.16 %) and left upper lobe was involved in 11 patients (45.84 %). Lobectomy was done in 16 patients (66.67 %), segmentectomy in 4 patients (16.66 %), and pneumonectomy in 4 patients (16.66 %). 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. 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.