Pulmonary Procedures |

Two Cases of Pulmonary Aspergilloma Treated by Cavernostomy FREE TO VIEW

Ryo Takahashi, MD; Michio Fujino, MD; Taiki Fujiwara, MD; Hisami Yamakawa, MD
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Department of Thoracic Surgery, National Hospital Organization Chiba-East-Hospital, Chiba, Japan

Chest. 2014;145(3_MeetingAbstracts):477A. doi:10.1378/chest.1835909
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SESSION TITLE: Bronchology Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Pulmonary aspergilloma is an intractable disease characterized by growth of the Aspergillus fungus to form fungus balls in preformed cavitary lesions of the lungs. Complete elimination of the fungus balls cannot be accomplished by antifungal treatment alone, and surgical pneumonectomy is recommended. We report two cases in which cavernostomy was performed because of recurrent infections of the residual lung and hemoptysis after operation for lung cancer.

CASE PRESENTATION: A 73-year-old man. He underwent right upper lobectomy and lymph node dissection (LND) at age 67. Six years after the surgery, blood was found in the sputum and a chest CT revealed evidence of a destroyed lung. Aspergillus fumigatus was detected in the exudate from the pulmonary cyst cavity, and the patient was diagnosed as having pulmonary aspergilloma. Cavernostomy was performed, purulent accretions were removed, and presence of a fungus ball was confirmed. A 63-year-old man. He underwent right lower lobectomy and LND at age 54. Controlling pneumonia with drugs became difficult at 7 years after the lung cancer surgery, and a chest CT revealed evidence of a destroyed lung. Cavernostomy was performed, and Aspergillus fumigatus was detected from the cavity. After the cavity was sterilized by cavernostomy, the residual lung was totally removed.

DISCUSSION: Both patients had impaired pulmonary function; the mean %FVC was 59.9% and the average forced expiratory volume in one second was 1.53 L. Evidence of a destroyed lung was seen in the postoperative images in both patients. The clinical condition could not be controlled by medical interventions in either patient, however, taking into consideration their general condition, pneumonectomy was also considered to be impossible. Therefore, we performed cavernostomy, which is considered to be applicable to patients with respiratory function disorder. Cavernostomy originated from Monaldi drainage, which is a surgical method employed for tuberculous cavities, in which germ-discharging cavities are closed after sterilizing them surgically. Relief of hemoptysis and complete response could be obtained in our patients too.

CONCLUSIONS: When cavernostomy is considered for late-onset pulmonary aspergillomas developing after lung cancer surgery, sufficient preoperative assessment to identify the causative fungus and the patient’s ability to withstand the surgery, as well as careful judgment of the indications, is necessary on a case-by-case basis.

Reference #1: Shirakusa T, Ueda H, Saito T, et al. Surgical treatment of pulmonary aspergilloma and Aspergillus empyema. Ann Thorac Surg. 1989 Dec;48(6):779-82.

Reference #2: Daly RC, Pairolero PC, Piehler JM, et al. Pulmonary aspergilloma results of surgical treatment. J Thorac Cardiovasc Surg 1986;92:981-8.

Reference #3: Oakley RE, Petrou M, Goldstraw P. Indications and outocome of surgery for pulmonary aspergilloma. Thorax 1997;52:813-5.

DISCLOSURE: The following authors have nothing to disclose: Ryo Takahashi, Michio Fujino, Taiki Fujiwara, Hisami Yamakawa

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