As compared to aspergilloma which is usually developed after complication of tuberculosis in Korea, endobronchial aspergilloma is a rare disease entity and clinical findings and natural course is not well known. We retrospectively analyze the clinical, radiological, and bronchoscopic finding and treatment options in patients confirmed as endobronchial aspergilloma.
From 1993 to 2005, eight patients were identified with endobronchial aspergilloma in Yongdong Severance hospital. We reviewed medical records for analysis of clinical, radiological, and bronchoscopic finding, and treatment options and result. All cases are confirmed as endobronchial aspergillosis by bronchoscopic biopsy and pathological finding. The patients ranged in age from 46 to 67 (mean 55.3). There are 3 males and 5 females.
All patients were symptomatic when hospitalization. Most common symptome is hemoptysis (100%), cough (63%), sputum (25%), chest discomfort (25%), and general weakness (13%). Most common underlying diseases were pulmonary tuberculosis (75%), bronchiectasis (25%), and small cell lung cancer (13%). Bronchoscopic finding is typical and more diagnostic than radiological findings. Seven out of eight cases had endobronchial aspergilloma in upper lobe bronchus. The location of endobronchial aspergilloma were right upper lobe bronchus (50%), left upper lobe bronchus (25%), left upper lobe lingular bronchus (13%), and lower lobe bronchus (13%). Endobronchial aspergilloma was developed right upper lobectomy stump site in a lung transplanted patient. Recurrent and moderate to large amount of hemoptysis was common, serious and unique symptoms. Five patients were surgically managed and the prognosis was good. A patient who refused surgery showed intermittent hemoptysis. Endobrochial aspergilloma in transplanated case and a case with acute pneumonia, DM and end stage renal disease was aggravated to invasive aspergillosis and patients were expired.
Endobronchial aspergilloma is unique form of aspergillosis followed by pulmonary tuberculosis and most common symptom is recurrent hemoptysis. Surgery is choice of treatment in immunecompetent patient.
Aspergillus organism in patient who had previous pulmonary tuberculosis occasionally forms endobronchial aspergilloma.
Doyun Kim, None.