Background: Aspergilloma is the localized form of pulmonary colonization by Aspergillus species, which often hosted within a pre-existing cavitary lesion. The Aspergilloma (commonly known as mycetoma or fungus ball) consists of fungal hyphae, aggregates of inflammatory cells, fibrin threads, and destructed tissues debris. Aspergillus Fumigatu is the commonest species responsible for such lesions. In this study, over 20 years, data were collected for examination, on the outcomes of surgery for pulmonary Aspergilloma. Methods: Retrospective study of 54 patients, dating from January 1996 and December, 2015. Each patient’s preoperative, diagnostic, operative, postoperative and follow up data was collected for analysis. Results: Findings of 54 patients who underwent surgery for Aspergilloma, 47 had clinical diagnosis. While remaining 7 were confirmed post-resection. The median age was 46.3±7.8 (aged 17-64 years). Risk assessment identified that greater probability for the Left Lung to be infected and increase if gender was male (2.6:1). The main presentation was hemoptysis, seen in 70.4% of cases, while symptoms of cough and expectoration occurred in 83.3% of them. The most prevalent predisposing factor was tuberculosis (TB), present in 57.4% of cases. The indication for surgery was recurrent hemoptysis, asymptomatic simple Aspergilloma and complex Aspergilloma. All the patients underwent pulmonary resection, with 82.5% of cases having lobectomy. The main postoperative complication was prolonged air leak 29.6% (16/54). The in-hospital mortality rate was 7.5% (6/54) patients. Conclusion: Surgery offered to Aspergilloma patients (fungus ball) brought beneficial results with an acceptable morbidity. The mortality observed within these cases, was predominantly due to high risk patients, with complex Aspergillosis. Recommendations for a multidisciplinary approach, in future cases, are paramount for better selection criteria.
| Published in | International Journal of Cardiovascular and Thoracic Surgery (Volume 6, Issue 5) |
| DOI | 10.11648/j.ijcts.20200605.12 |
| Page(s) | 60-65 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2020. Published by Science Publishing Group |
Fungus Ball, Hyphae, Aspergilloma, Cavity, Hemoptysis, Lobectomy
| [1] | Kasprzyk M, Pieczyński K, Mania K, Gabryel P, Piwkowski C, and Dyszkiewicz W. Surgical treatment for pulmonary aspergilloma- early and long-term results. Kardiochir Torakochirurgia Pol. 2017 Jun; 14 (2): 99–103. |
| [2] | Youssef C, and Widlus DM. Imaging diagnosis of aspergilloma. J Community Hosp Intern Med Perspect. 2012; 2 (1): 10. |
| [3] | Kurul IC, Demircan S, Yazici U, Altinok T, Topcu S, Unlü M. Surgical management of pulmonary aspergilloma. Asian CardiovascThorac Ann. 2004; 12 (4): 320-323. |
| [4] | Greene R. The radiological spectrum of pulmonary aspergillosis. Medical Mycology Supplement 1 2005, 43, S147-S154. |
| [5] | Ocakcioglu I, Ermerak NO, Yildizeli B. Uniportal Video-assisted Thoracoscopic Surgery for Pulmonary Aspergilloma: A Report of 5 Cases SurgLaparoscEndoscPercutan Tech. 2019; 29 (4): e37-e40. |
| [6] | Regnard J, Icard P, Nicolosi M, Spagiarri L, Magdeleinat P, Jauffret B, et al. Aspergilloma: a series of 89 surgical cases. Ann Thorac Surg 2000; 69: 898–903. |
| [7] | Park CK, Jheon S. Results of surgical treatment for pulmonary aspergilloma. Eur J Cardiothorac Surg. 2002; 21: 918–923. |
| [8] | Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest. 2002; 121: 1988–1999. |
| [9] | Akbari JG, Varma PK, Neema PK, Menon MU, Neelakandhan KS. Clinical profile and surgical outcome for pulmonary aspergilloma: a single center experience. Ann Thorac Surg. 2005; 80: 1067–1072. |
| [10] | Massard G, Roeslin N, Wihlm JM, Dumont P, Witz JP, Morand G. Pleuropulmonary aspergilloma: clinical spectrum and results of surgical treatment. Ann Thorac Surg. 1992; 54: 1159–1164. |
| [11] | Al-Orainey I, Alhedaithy MA, Alanazi AR, Barry MA, and Almajid F. Tuberculosis incidence trends in Saudi Arabia over 20 years: 1991-2010. Ann Thorac Med. 2013 Jul-Sep; 8 (3): 148–152. |
| [12] | Raveendran S. and Lu Z., CT findings and differential diagnosis in adults with invasive pulmonary aspergillosis. Radiology of Infectious Diseases 2018, (5) 14-25. https://doi.org/10.1016/j.jrid.2018.01.004. |
| [13] | Massard G, Dabbagh A, Kessler R, Barsotti P, Roeslin N, Morand G. Pneumonectomy for chronic infection is a high-risk procedure. Ann Thorac Surg. 1996; 62: 1033–1038. |
| [14] | Shiraishi Y, Katsuragi N, Nakajima Y, Hashizume M, Takahashi N, Miyasaka Y. Pneumonectomy for complex aspergilloma: is it still dangerous? Eur J Cardiothorac Surg. 2006; 29: 9–13. |
| [15] | Rafferty P, Biggs BA, Crompton GK, Grant IW. What happens to patients with pulmonary aspergilloma? Analysis of 23 cases. Thorax. 1983; 38: 579–83. |
| [16] | Franquet T., Mu’ller N., Giménez A., Guembe P., La Torre J., Bague S.; Spectrum of Pulmonary Aspergillosis: Histologic, Clinical, and Radiologic Findings. RadioGraphics 2001; 21: 825-837. |
| [17] | Sagan D, Goździuk K. Surgery for pulmonary aspergilloma in immunocompetent patients: no benefit from adjuvant antifungal pharmacotherapy. Ann Thorac Surg. 2010; 89: 1603–1610. |
| [18] | Farid S, Mohamed S, Devbhandari M, Kneale M, Richardson M, Soon SY, Jones MT, Krysiak P, Shah R, Denning DW, Rammohan K. Results of surgery for chronic pulmonary Aspergillosis, optimal antifungal therapy and proposed high risk factors for recurrence-a National Centre’s experience. J Cardiothorac Surg. 2013; 8: 180. |
APA Style
Hysam Abdelmohty, Salah Eldin Khalaf, Walid Hassan, Ahmed Mostafa, Mohamed-Adel Elanwar. (2020). Evolution of Surgery Offered to Aspergilloma over 2 Decades, Institutional Report. International Journal of Cardiovascular and Thoracic Surgery, 6(5), 60-65. https://doi.org/10.11648/j.ijcts.20200605.12
ACS Style
Hysam Abdelmohty; Salah Eldin Khalaf; Walid Hassan; Ahmed Mostafa; Mohamed-Adel Elanwar. Evolution of Surgery Offered to Aspergilloma over 2 Decades, Institutional Report. Int. J. Cardiovasc. Thorac. Surg. 2020, 6(5), 60-65. doi: 10.11648/j.ijcts.20200605.12
AMA Style
Hysam Abdelmohty, Salah Eldin Khalaf, Walid Hassan, Ahmed Mostafa, Mohamed-Adel Elanwar. Evolution of Surgery Offered to Aspergilloma over 2 Decades, Institutional Report. Int J Cardiovasc Thorac Surg. 2020;6(5):60-65. doi: 10.11648/j.ijcts.20200605.12
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Download@article{10.11648/j.ijcts.20200605.12,
author = {Hysam Abdelmohty and Salah Eldin Khalaf and Walid Hassan and Ahmed Mostafa and Mohamed-Adel Elanwar},
title = {Evolution of Surgery Offered to Aspergilloma over 2 Decades, Institutional Report},
journal = {International Journal of Cardiovascular and Thoracic Surgery},
volume = {6},
number = {5},
pages = {60-65},
doi = {10.11648/j.ijcts.20200605.12},
url = {https://doi.org/10.11648/j.ijcts.20200605.12},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20200605.12},
abstract = {Background: Aspergilloma is the localized form of pulmonary colonization by Aspergillus species, which often hosted within a pre-existing cavitary lesion. The Aspergilloma (commonly known as mycetoma or fungus ball) consists of fungal hyphae, aggregates of inflammatory cells, fibrin threads, and destructed tissues debris. Aspergillus Fumigatu is the commonest species responsible for such lesions. In this study, over 20 years, data were collected for examination, on the outcomes of surgery for pulmonary Aspergilloma. Methods: Retrospective study of 54 patients, dating from January 1996 and December, 2015. Each patient’s preoperative, diagnostic, operative, postoperative and follow up data was collected for analysis. Results: Findings of 54 patients who underwent surgery for Aspergilloma, 47 had clinical diagnosis. While remaining 7 were confirmed post-resection. The median age was 46.3±7.8 (aged 17-64 years). Risk assessment identified that greater probability for the Left Lung to be infected and increase if gender was male (2.6:1). The main presentation was hemoptysis, seen in 70.4% of cases, while symptoms of cough and expectoration occurred in 83.3% of them. The most prevalent predisposing factor was tuberculosis (TB), present in 57.4% of cases. The indication for surgery was recurrent hemoptysis, asymptomatic simple Aspergilloma and complex Aspergilloma. All the patients underwent pulmonary resection, with 82.5% of cases having lobectomy. The main postoperative complication was prolonged air leak 29.6% (16/54). The in-hospital mortality rate was 7.5% (6/54) patients. Conclusion: Surgery offered to Aspergilloma patients (fungus ball) brought beneficial results with an acceptable morbidity. The mortality observed within these cases, was predominantly due to high risk patients, with complex Aspergillosis. Recommendations for a multidisciplinary approach, in future cases, are paramount for better selection criteria.},
year = {2020}
}
TY - JOUR T1 - Evolution of Surgery Offered to Aspergilloma over 2 Decades, Institutional Report AU - Hysam Abdelmohty AU - Salah Eldin Khalaf AU - Walid Hassan AU - Ahmed Mostafa AU - Mohamed-Adel Elanwar Y1 - 2020/11/09 PY - 2020 N1 - https://doi.org/10.11648/j.ijcts.20200605.12 DO - 10.11648/j.ijcts.20200605.12 T2 - International Journal of Cardiovascular and Thoracic Surgery JF - International Journal of Cardiovascular and Thoracic Surgery JO - International Journal of Cardiovascular and Thoracic Surgery SP - 60 EP - 65 PB - Science Publishing Group SN - 2575-4882 UR - https://doi.org/10.11648/j.ijcts.20200605.12 AB - Background: Aspergilloma is the localized form of pulmonary colonization by Aspergillus species, which often hosted within a pre-existing cavitary lesion. The Aspergilloma (commonly known as mycetoma or fungus ball) consists of fungal hyphae, aggregates of inflammatory cells, fibrin threads, and destructed tissues debris. Aspergillus Fumigatu is the commonest species responsible for such lesions. In this study, over 20 years, data were collected for examination, on the outcomes of surgery for pulmonary Aspergilloma. Methods: Retrospective study of 54 patients, dating from January 1996 and December, 2015. Each patient’s preoperative, diagnostic, operative, postoperative and follow up data was collected for analysis. Results: Findings of 54 patients who underwent surgery for Aspergilloma, 47 had clinical diagnosis. While remaining 7 were confirmed post-resection. The median age was 46.3±7.8 (aged 17-64 years). Risk assessment identified that greater probability for the Left Lung to be infected and increase if gender was male (2.6:1). The main presentation was hemoptysis, seen in 70.4% of cases, while symptoms of cough and expectoration occurred in 83.3% of them. The most prevalent predisposing factor was tuberculosis (TB), present in 57.4% of cases. The indication for surgery was recurrent hemoptysis, asymptomatic simple Aspergilloma and complex Aspergilloma. All the patients underwent pulmonary resection, with 82.5% of cases having lobectomy. The main postoperative complication was prolonged air leak 29.6% (16/54). The in-hospital mortality rate was 7.5% (6/54) patients. Conclusion: Surgery offered to Aspergilloma patients (fungus ball) brought beneficial results with an acceptable morbidity. The mortality observed within these cases, was predominantly due to high risk patients, with complex Aspergillosis. Recommendations for a multidisciplinary approach, in future cases, are paramount for better selection criteria. VL - 6 IS - 5 ER -
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