A Series of Transbronchial Removal of Intracavitary Pulmonary Aspergilloma

• Published in: The Annals of thoracic surgery Vol. 103; no. 3; pp. 945 - 950
• Main Authors: Stather, David R., MD, FRCPC, Tremblay, Alain, MDCM, FRCPC, Dumoulin, Elaine, MDCM, FRCPC, MacEachern, Paul, MD, FRCPC, Chee, Alex, MD, FRCPC, Hergott, Christopher, MD, FRCPC, Gelberg, Jacob, MD, FRCPC, Gelfand, Gary A., MD, FRCPC, Burrowes, Paul, MD, FRCPC, MacGregor, John H., MD, FRCPC, Mody, Christopher H., MD, FRCPC
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.03.2017
• Subjects: Adult; Aged; Alberta; Bronchoscopy; Cardiothoracic Surgery; Female; Humans; Male; Middle Aged; Operative Time; Patient Selection; Pulmonary Aspergillosis - complications; Pulmonary Aspergillosis - diagnostic imaging; Pulmonary Aspergillosis - surgery; Retrospective Studies; Surgery; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2016.08.069

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.