Incidence and surgical outcome of pulmonary aspergilloma

Background: Pulmonary aspergillosis is a spectrum of mycotic diseases caused by Aspergillus species, usually Aspergillus fumigatus. Pulmonary aspergilloma is the most common form. This form is non-invasive and involves the colonization of pre- existing cavities. Objectives: (1) To assess the incidence of Aspergillus infection in various lung cavities admitted to Department of CVTS; (2) To assess the surgical outcome of pulmonary aspergilloma. Material & Methods: A retrospective analysis (from January 2000 to April 2006) of patient records and prospective (from May 2006 to October 2008) study of patients of pulmonary aspergilloma operated in the Department was done. Results: 52 patients (males, 61%) were operated for pulmonary aspergilloma during the study period; constituting one percent of all admissions to the Department of CVTS. The mean age of patients was 39.3±11.2 years. Episodic hemoptysis was the commonest mode of presentation (96%). The duration of hemoptysis ranged from one month to 48 months. Tuberculosis was the most common underlying lung pathology (80.7%), followed by bronchiectasis (11.5%) and lung abscess (5.7%). In one of our patients, concomitant ruptured lung hydatid cyst was present. 90% of the patients had aspergilloma present in upper lobes. Lobectomy was the most common procedure performed (82%), followed by bilobectomy (6%), segmentectomy (6%) and pneumonectomy (6%). Postoperative mortality was 2% only. Postoperative non-fatal complications included incomplete re-expansion (15.5%), prolonged air leak (11.5%), bleeding (5.7%), wound infection (2%) and empyema (2%). The median survival was 36 months (95% C. I., 26-46) with a mean follow-up of 33±18.6 months. There was no recurrence of hemoptysis or pulmonary aspergilloma in any patient. Conclusions: Surgical resection is the most effective treatment for pulmonary aspergilloma. Preoperative preparation of the patient, meticulous surgical technique and post operative chest physiotherapy reduces the rate of complications. Complications may still occur and are largely related to the underlying lung pathology; however, the long term outcome is good