Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1983 Aug;38(8):572–578. doi: 10.1136/thx.38.8.572

Pulmonary aspergilloma: analysis of prognosis in relation to haemoptysis and survey of treatment.

J Jewkes, P H Kay, M Paneth, K M Citron
PMCID: PMC459613  PMID: 6612647

Abstract

From 1956 to 1980 85 patients were admitted to the Brompton Hospital, London, with pulmonary aspergilloma. The mean follow-up period was 8.7 years and 85% of patients were followed for five years or until death if this was earlier. There were 41 deaths, 27 from respiratory causes: 11 from pneumonia, six from chronic respiratory failure, seven after surgery for aspergilloma, and three from haemoptysis. Medical treatment alone was given to 36 patients, of whom three died of haemoptysis. Systemic antifungal treatment was given to 18 patients without benefit. Intracavitary antifungals were helpful in three out of 10 patients. Surgical resection was performed in 41 patients, of whom three (7%) died after operation and a further six (15%) developed major complications. Cavernostomy was performed in nine patients considered unfit for resection; four died after operation. Haemoptysis was absent or minor in 40 patients, of whom 19 were treated medically and 18 by resection, with similar five-year survival rates of 65% and 75%. Frank or major haemoptysis occurred in 45 patients, of whom 17 were treated medically and 23 by resection, with five-year survivals of 41% and 84% (p less than 0.02). The better survival of the surgical group in this retrospective survey may have been due to the selection of patients with better lung function and more localised pulmonary disease. Our observations suggest that surgical resection for aspergilloma should be restricted to patients with severe haemoptysis and adequate pulmonary function. In patients unfit for resection cavernostomy is hazardous.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson C. J., Craig S., Bardana E. J., Jr Allergic bronchopulmonary aspergillosis and bilateral fungal balls terminating in disseminated aspergillosis. J Allergy Clin Immunol. 1980 Feb;65(2):140–144. doi: 10.1016/0091-6749(80)90199-2. [DOI] [PubMed] [Google Scholar]
  2. Aslam P. A., Eastridge C. E., Hughes F. A., Jr Aspergillosis of the lung--an eighteen-year experience. Chest. 1971 Jan;59(1):28–32. doi: 10.1378/chest.59.1.28. [DOI] [PubMed] [Google Scholar]
  3. Faulkner S. L., Vernon R., Brown P. P., Fisher R. D., Bender H. W., Jr Hemoptysis and pulmonary aspergilloma: operative versus nonoperative treatment. Ann Thorac Surg. 1978 May;25(5):389–392. doi: 10.1016/s0003-4975(10)63570-9. [DOI] [PubMed] [Google Scholar]
  4. GOLBERG B. Radiological appearances in pulmonary aspergillosis. Clin Radiol. 1962 Apr;13:106–114. doi: 10.1016/s0009-9260(62)80030-0. [DOI] [PubMed] [Google Scholar]
  5. Garvey J., Crastnopol P., Weisz D., Khan F. The surgical treatment of pulmonary aspergillomas. J Thorac Cardiovasc Surg. 1977 Oct;74(4):542–547. [PubMed] [Google Scholar]
  6. Henderson A. H., Pearson J. E. Treatment of bronchopulmonary aspergillosis with observations on the use of natamycin. Thorax. 1968 Sep;23(5):519–523. doi: 10.1136/thx.23.5.519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Henderson R. D., Deslaurier J., Ritcey E. L., Delarue N. C., Pearson F. G. Surgery in pulmonary aspergillosis. J Thorac Cardiovasc Surg. 1975 Dec;70(6):1088–1094. [PubMed] [Google Scholar]
  8. Karas A., Hankins J. R., Attar S., Miller J. E., McLaughlin J. S. Pulmonary aspergillosis: an analysis of 41 patients. Ann Thorac Surg. 1976 Jul;22(1):1–7. doi: 10.1016/s0003-4975(10)63943-4. [DOI] [PubMed] [Google Scholar]
  9. Kilman J. W., Ahn C., Andrews N. C., Klassen K. Surgery for pulmonary aspergillosis. J Thorac Cardiovasc Surg. 1969 May;57(5):642–647. [PubMed] [Google Scholar]
  10. Krakówka P., Traczyk K., Walczak J., Halweg H., Elsner Z., Pawlicka L. Local treatment of aspergilloma of the lung with a paste containing nystatin or amphotericin B. Tubercle. 1970 Jun;51(2):184–191. doi: 10.1016/0041-3879(70)90071-1. [DOI] [PubMed] [Google Scholar]
  11. LOECKELL H. UBER DIE TRANSTHORAKALE AUSRAEUMUNG EINES LUNGENMYZETOMS MITTELS MAURERDRAINAGE. Prax Pneumol. 1964 Nov;18:757–762. [PubMed] [Google Scholar]
  12. LONGBOTTOM J. L., PEPYS J. PULMONARY ASPERGILLOSIS: DIAGNOSTIC AND IMMUNOLOGICAL SIGNIFICANCE OF ANTIGENS AND C-SUBSTANCE IN ASPERGILLUS FUMIGATUS. J Pathol Bacteriol. 1964 Jul;88:141–151. doi: 10.1002/path.1700880119. [DOI] [PubMed] [Google Scholar]
  13. McCarthy D. S., Pepys J. Pulmonary aspergilloma--clinical immunology. Clin Allergy. 1973 Mar;3(1):57–70. doi: 10.1111/j.1365-2222.1973.tb01310.x. [DOI] [PubMed] [Google Scholar]
  14. RAMIREZ J. PULMONARY ASPERGILLOMA: ENDOBRONCHIAL TREATMENT. N Engl J Med. 1964 Dec 17;271:1281–1285. doi: 10.1056/NEJM196412172712502. [DOI] [PubMed] [Google Scholar]
  15. Rémy J., Arnaud A., Fardou H., Giraud R., Voisin C. Treatment of hemoptysis by embolization of bronchial arteries. Radiology. 1977 Jan;122(1):33–37. doi: 10.1148/122.1.33. [DOI] [PubMed] [Google Scholar]
  16. Saab S. B., Almond C. Surgical aspects of pulmonary aspergillosis. J Thorac Cardiovasc Surg. 1974 Sep;68(3):455–460. [PubMed] [Google Scholar]
  17. Shneerson J. M., Emerson P. A., Phillips R. H. Radiotherapy for massive haemoptysis from an aspergilloma. Thorax. 1980 Dec;35(12):953–954. doi: 10.1136/thx.35.12.953. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Solit R. W., McKeown J. J., Jr, Smullens S., Fraimow W. The surgical implications of intracavitary mycetomas (fungus balls). J Thorac Cardiovasc Surg. 1971 Sep;62(3):411–422. [PubMed] [Google Scholar]
  19. Soltanzadeh H., Wychulis A. R., Sadr F., Bolanowski P. J., Neville W. E. Surgical treatment of pulmonary aspergilloma. Ann Surg. 1977 Jul;186(1):13–16. doi: 10.1097/00000658-197707000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Varkey B., Rose H. D. Pulmonary aspergilloma. A rational approach to treatment. Am J Med. 1976 Nov;61(5):626–631. doi: 10.1016/0002-9343(76)90140-6. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES