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Original Research: Chest Infections |

A Modern Series of Percutaneous Intracavitary Instillation of Amphotericin B for the Treatment of Severe Hemoptysis From Pulmonary AspergillomaIntracavitary Amphotericin B for Aspergilloma

Jared N. Kravitz, MD; Max W. Berry, MD; Stephen I. Schabel, MD; Marc A. Judson, MD, FCCP
Author and Funding Information

From the Department of Medicine (Dr Kravitz), University of Tennessee Medical Center, Knoxville, TN; Department of Radiology (Drs Berry and Schabel), Medical University of South Carolina, Charleston, SC; and Division of Pulmonary and Critical Care Medicine (Dr Judson), Albany Medical College, Albany, NY.

Correspondence to: Marc A. Judson, MD, FCCP, Division of Pulmonary and Critical Care Medicine, MC-91, 47 New Scotland Ave, Albany Medical College, Albany, NY 12208; e-mail: judsonm@mail.amc.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.


Chest. 2013;143(5):1414-1421. doi:10.1378/chest.12-1784
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Background:  Pulmonary aspergillomas may cause life-threatening hemoptysis. The treatment of this condition is problematic because poor pulmonary function often precludes definitive surgical resection.

Methods:  We retrospectively reviewed all patients hospitalized at our institution for hemoptysis associated with an aspergilloma over an 8-year period and who underwent percutaneous intracavitary instillation of amphotericin B (ICAB). ICAB consisted of catheter placement into the aspergilloma cavity with subsequent instillation of 50 mg amphotericin B in 20 mL 5% dextrose solution daily for 10 days.

Results:  ICAB was attempted for 23 distinct episodes of severe hemoptysis in 20 individual patients. Catheter placement was successful in 21 of the 23 episodes (91%), and of these, ICAB instillation was successfully completed in 20 episodes (95%). In these 20 episodes, hemoptysis ceased by hospital discharge in 17 of 20 patients (85%) and in all 18 who survived until a follow-up visit 1-month after treatment. Pneumothorax occurred in six of 23 (26%) catheter placement attempts without long-term complications. Recurrence of serious hemoptysis occurred after six of 18 episodes for which follow-up was available. Potential risk factors associated with severe, recurrent hemoptysis were a size increase or reappearance of the aspergilloma on a chest CT scan (P = .001), bleeding diathesis (P = .08), and lack of bronchial artery embolization during index hospitalization (P = .07).

Conclusions:  Our data suggest that ICAB is an effective short-term treatment to control severe hemoptysis caused by pulmonary aspergilloma. The long-term benefit of this procedure is unknown. We identified several potential risk factors for recurrent hemoptysis after ICAB that could be examined prospectively in future trials.

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