Surgical management of pulmonary aspergilloma A multidisciplinary approach to management


Shane Ahern, M Khan, K Papa, V Siddah, E O Broin and J Hinchion

Background: A pulmonary aspergillomas is a mass of saprophytic aspergillosis that usually forms in a pre-existing cavity within the lung parenchyma. It is usually detected radiologically or via serum antigens. Complications of pulmonary aspergillomas include respiratory failure and massive haemoptysis; the latter of which can often be fatal. Medical management alone has yet proved ineffective, so surgery is currently a mainstay of treatment. Morbidity and mortality related to earlier surgical interventions were high but recent techniques have improved upon this greatly. Cavernostomy with a lattisimus dorsi flap is one such method. Case: A 59-year-old lady with a background of an old tuberculosis infection- 36 years prior- presented with recurrent episodes of haemoptysis. Computed tomography (CT) revealed a persistent left upper lobe cavitation containing a pulmonary aspergilloma. Surgical intervention was delayed due to the separate developments of a cerebral abscess and of appendicitis. Eventually, a combined cardiothoracic and plastic operation led to a cavernostomy formation with removal of the aspergilloma. The cavity was then lavaged with antifungal medication and filled with a lattismus dorsi muscle flap. Post-operatively, she was treated with a prolonged course of voriconazole. Conclusion: Surgical management can offer definitive treatment of pulmonary aspergilloma.

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