David R Stather1, Alain Tremblay1, Elaine Dumoulin2, Paul MacEachern1, Alex Chee1, Christopher Hergott1, Jacob Gelberg3, Gary A Gelfand4, Paul Burrowes5, John H MacGregor5, Christopher H Mody6. 1. Department of Medicine, University of Calgary, Calgary, Alberta, Canada. 2. Department of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: elaine.dumoulin@albertahealthservices.ca. 3. Department Medicine, McMaster University, Hamilton, Ontario, Canada. 4. Department of Surgery, Immunology and Infectious Disease, University of Calgary, Calgary, Alberta, Canada. 5. Department of Radiology, Immunology and Infectious Disease, University of Calgary, Calgary, Alberta, Canada. 6. Department of Microbiology, Immunology and Infectious Disease, University of Calgary, Calgary, Alberta, Canada.
Abstract
BACKGROUND: Intracavitary pulmonary aspergilloma is a chronic, debilitating fungal infection. Without definitive therapy, death can occur from massive hemoptysis, cachexia, or secondary infection. Although surgical resection is the standard therapy, it is not possible for many patients owing to poor pulmonary function or medical comorbidities. Aspergilloma removal through bronchoscopy is an important alternative therapy that may be available in select cases. METHODS: We retrospectively reviewed all cases referred to the University of Calgary Interventional Pulmonary Service for transbronchial removal of intracavitary aspergilloma from January 1, 2009, to January 1, 2014. RESULTS: Ten patients with intracavitary pulmonary aspergilloma were identified. In 3 patients, the aspergilloma cavity was not accessible by bronchoscopy. Successful removal of the aspergilloma with symptom improvement or resolution was achieved in 6 of 7 cases. One of the patients was lost to follow-up. Minor hypoxia lasting 12 to 72 hours was observed in 5 cases. Severe sepsis requiring an extended critical care unit stay occurred in 1 case. Follow-up ranged from 9 months to 5 years. CONCLUSIONS: Although not without risk of minor hypoxia and possible sepsis, for carefully selected patients, bronchoscopic removal of symptomatic intracavitary pulmonary aspergilloma may be an alternative therapy to surgical resection for this life-threatening disease.
BACKGROUND: Intracavitary pulmonary aspergilloma is a chronic, debilitating fungal infection. Without definitive therapy, death can occur from massive hemoptysis, cachexia, or secondary infection. Although surgical resection is the standard therapy, it is not possible for many patients owing to poor pulmonary function or medical comorbidities. Aspergilloma removal through bronchoscopy is an important alternative therapy that may be available in select cases. METHODS: We retrospectively reviewed all cases referred to the University of Calgary Interventional Pulmonary Service for transbronchial removal of intracavitary aspergilloma from January 1, 2009, to January 1, 2014. RESULTS: Ten patients with intracavitary pulmonary aspergilloma were identified. In 3 patients, the aspergilloma cavity was not accessible by bronchoscopy. Successful removal of the aspergilloma with symptom improvement or resolution was achieved in 6 of 7 cases. One of the patients was lost to follow-up. Minor hypoxia lasting 12 to 72 hours was observed in 5 cases. Severe sepsis requiring an extended critical care unit stay occurred in 1 case. Follow-up ranged from 9 months to 5 years. CONCLUSIONS: Although not without risk of minor hypoxia and possible sepsis, for carefully selected patients, bronchoscopic removal of symptomatic intracavitary pulmonary aspergilloma may be an alternative therapy to surgical resection for this life-threatening disease.
Authors: Alain Tremblay; Alex C Chee; Inderdeep Dhaliwal; Elaine Dumoulin; Ashley Gillson; Paul R MacEachern; Michael Mitchell; Colin Schieman; Daniel Stollery; Pen Li; Marc Fortin; Chung C Tyan; Erik Vakil; Christopher Hergott Journal: BMJ Open Respir Res Date: 2021-01