Surgical Approach to Pulmonary Aspergilloma

Pulmonary aspergilloma is a potentially life-threatening disease resulting from the colonization of lung cavities by the Aspergillus fumigatus. This study was performed to find out the role of surgical treatment in pulmonary aspergillomas. In our center, between 1987 and 2002, 42 patients underwent a total of 43 operations for treatment of pulmonary aspergilloma. The patients were comprised of 29 males and 13 females, with a mean age of 32 years (range, 2168). The underlying lung disease was tuberculosis in 38 (90.5%) cases. There was typical fungus ball and air-crescent sign in the chest radiographies of 21 (50%) patients. Indications for surgical intervention were life-threatening or recurrent hemoptysis in 29 (69%) patients and destroyed lobe or lung in 12 patients (28.6%). Twenty-six (61.9%) lobectomies (one with associated segmentectomy), 6 pneumonectomies, 8 cavernomyoplasties, 1 bilateral upper lobectomy and 1 thoracomyoplasty were performed. There were three postoperative deaths (7.1%). Complications were, prolonged air leak and/or empyema (5), bronchopleural fistula (2), bleeding (2) and wound infection (2). Tuberculosis is the most frequent disease associated with pulmonary aspergilloma. Surgical resection is the most effective treatment in pulmonary aspergilloma. If resection can not be performed because of limited pulmonary functions and poor general condition, cavernomyoplasty should be performed as a life saving procedure.