[Results of surgical treatment for pulmonary aspergilloma]

Abstract

Introduction: Aspergilloma results from the development, inside preexisting pulmonary cavities, of aspergillus spores. It is most commonly manifested by hemoptysis. The goal of this retrospective study is to report our surgical experience of this disease.

Patients and methods: From January 2004 to December 2008, 35 patients underwent surgery at the same center for pulmonary aspergilloma. We examined the epidemiological, clinical, paraclinical, therapeutic, and outcome data.

Results: The patients' median age was 43.37 years (range: 20-70 years), 28 were male. The average time to consultation was 19.35 months (1-120 months), and all patients had a history of pulmonary tuberculosis. Hemoptysis was the symptom observed most often, in 54.3% of patients, followed by bronchorrhea. Aspergillus serology was positive for 22 patients. The standard radiological image was found in 20 patients. We performed 14 lobectomies, 1 bilobectomy, 1 segmentectomy, 1 bisegmentectomy, 3 lobectomies with segmentectomies, 1 bilobectomy with segmentectomy, and 14 pleuropneumonectomies. In one case, the pulmonary artery was damaged and repaired. The average duration of intensive care was 3.54 days (2-7 days) and of total hospitalization, 17.33 days (7-48). Complications were: empyema (3 cases), a large air leak (1 case), parietal suppuration (5 cases), and pleural effusion, which was drained (3 cases). There was no postoperative mortality. After 35 months (1-72), one case of recurrent hemoptysis by reinfestation was observed. Three patients died of respiratory failure, one at 6 months and the other two at 1 year after the surgery.

Conclusion: Despite the associated morbidity, surgical treatment of pulmonary aspergilloma must be proposed systematically to these subjects presenting hemoptysis.

Keywords: aspergilloma; hemoptysis; pulmonary surgery; tuberculosis.