Clinical Characteristics of Pulmonary Aspergilloma.
10.4046/trd.1997.44.6.1308
- Author:
Tae Kyung KANG
1
;
Chang Ho KIM
;
Jae Yong PARK
;
Tae Hoon JUNG
;
Jun Ho LEE
;
Seong Beom HAN
;
Young Jun JEON
;
Jeong Ho SOHN
;
Ki Beom KIM
;
Jin Hong CHUNG
;
Kwan Ho LEE
;
Hyun Woo LEE
;
Hyeon Soo SHIN
;
Sang Chae LEE
;
Sam KWEON
Author Information
1. Department of Internal Medicine, College of Medicine, Kyunpook National University, Taegu, Korea.
- Publication Type:Original Article
- Keywords:
Pulmonary Aspergilloma
- MeSH:
Amphotericin B;
Aspergillus;
Chest Pain;
Colon;
Cough;
Daegu;
Diagnosis;
Dyspnea;
Empyema;
Female;
Fever;
Fistula;
Follow-Up Studies;
Fungi;
Hemoptysis;
Hemorrhage;
Hospitals, University;
Humans;
Lung Diseases;
Male;
Mastectomy, Segmental;
Mortality;
Pneumonectomy;
Postoperative Complications;
Precipitin Tests;
Respiratory Insufficiency;
Sepsis;
Thorax;
Tomography, X-Ray Computed;
Tuberculosis, Pulmonary;
Vocal Cord Paralysis;
Weight Loss
- From:Tuberculosis and Respiratory Diseases
1997;44(6):1308-1317
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Pulmonary aspergillomas usually arise from colonization and proliferation of Aspergillus in preexisting cavitary lung disease of any cause. About 15% of patients with tuberculous pulmonary cavities were found to have aspergilloma. We analyzed the clinical features and course of 91 patients with pulmonary aspergllloma. METHODS: During the ten-year period from June 1986 to May 1996, 91 patients whose condition was diagnosed as pulmonary aspergilloma at 4 university hospitals in Taegu city were reviewed. All patients fulfilled one of the following criteria: 1) histologic evidence of aspergilloma within abnormal air space in tissue sections, or 2) a positive Aspergillus serum precipitin test with the radiologic finding of a fungus ball. The histological diagnosis was established in 81 patients(89.0%) and clinical diagnosis in 10 patients(11.0%). RESULTS: 1) The age range was 22 to 65 years, with an average of 45 years. A male and female ratio was 1.7:1 (57men and 34 women). 2) Hemoptysis was far the most frequent symptom(89%), followed by cough, dyspnea, weakness, weight loss, fever, chest pain. 3) In all but 14 cases(15.4%) there had been associated conditions. Pulmonary tuberculosis was far the most frequent underlying condition found(74.7%), followed by bronchiectasis(6.6%), cavitary neoplasm(2.2%), pulmonary sequestration(1.1%). 4) The involved area was usually in the upper lobes ; the right upper lobe was involved in 39(42.9%), the left upper lobe in 31(34.1%), the left lower lobe in 13(14.3%), the right lower lobe in 7(7.7%), and the right middle lobe in 1(1.1%). 5) On standard chest roent geno gram the classic "bell-like" image of a fungus ball was found in 62.6% of the subjects. On CT scan, 88.1% of the subjects in which they were done. 6) The surgical therapy was undertaken in 76 patients, and medical therapy in 15 patients, including 4 patients with intracavitary instillation of amphotericin B. 7) The surgical modality was lobectomy in 55 patients(72.4%), segmentectomy in 16 patients(21.1%), pneumonectomy in 4 patients(5.3%), wedge resection in 1 patient(1.3%). The mortality rate was 3.9% (3 patients) ; 2 patients died of sepsis and 1 died of hemoptysis. The postoperative complications were encountered in 6 patients(7.9%), including each one patient with respiratory failure, bleeding, bronchopleural fistula, empyema, and vocal cord paralysis. 8) In the follow-up cases, each 2 patients of 71 patients with surgical treatment and 10 patients with medical treatment had recurrent hemoptysis. CONCLUISON: During follow-up of the chronic pulmonary disease with abnormal air space, if the standard chest roentgenograms are insufficient to detect a fungus ball, computed tomographic scan and serum precipitin test are likely to aid the diagnosis of patients with suspected pulmonary aspergilloma. A reasonable recommendation for management of a patient with aspergilloma would be to reserve surgical resection for those patients who have had severe, recurrent hemoptysis. And a well controlled cooperative study to the medical treatment such as intracavitary antifungal therapy is further needed.
