Skip to main content
SpringerLink
Log in

Surgical management of pulmonary aspergilloma—12 years’ experience from a tertiary care centre in India

  • Original Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Introduction and purpose

Pulmonary aspergilloma is the formation of saprophytic colonies of fungus in pre-existing pulmonary cavities. They may cause life-threatening haemoptysis. As medical treatment often fails, surgery is the mainstay of treatment in symptomatic patients. Earlier studies had reported high levels of mortality and morbidity with surgery while more recent studies have shown better results. Hence, being in a large tertiary care centre in India, we decided to analyse the details of our own experience in the surgical management of pulmonary aspergilloma.

Methods

Details of all adult patients treated surgically for pulmonary aspergilloma, between the years 2009 and 2020, maintained in a live database in our institute, were retrieved and analysed.

Results

There were 102 patients in the study. The average age was 40 years. There was a male (M: F, 3:1) and right side preponderance. Pulmonary tuberculosis (TB) was the commonest cause for cavities in which aspergilloma developed as identified in 84 (82%) patients and diabetes mellitus, the commonest comorbidity present in 28 (27.5%) patients. Parenchyma-preserving lung resections (PPLRs) were feasible in 8 (44%) of the non-tubercular patients, but only in 14 (17%) of the TB patients. Post-operative complications (11.7%) were higher among the patients with TB. There were 2 (1.9%) post-operative mortalities.

Conclusion

Though surgery is technically complex in the presence of pulmonary aspergilloma, it is yielding better results with improvements in treatment strategies. Surgery for aspergilloma in patients with prior or current pulmonary TB has more morbidity and mortality when compared to the non-TB patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Campbell MJ, Clayton YM. Bronchopulmonary aspergillosis. A correlation of the clinical and laboratory findings in 272 patients investigated for bronchopulmonary aspergillosis. Am Rev Respir Dis. 1964;89:186–96.

    CAS  PubMed  Google Scholar 

  2. Belcher J, Pulmmer N. Surgery in broncho-pulmonary aspergillosis. Br J Dis Chest. 1960;54:335–41.

    Article  Google Scholar 

  3. Pennington JE. Aspergillus lung disease. Med Clin North Am. 1980;64:475–90.

    Article  CAS  Google Scholar 

  4. Daly RC, Pairolero PC, Piehler JM, Trastek VF, Payne WS, Bernatz PE. Pulmonary aspergilloma. Results of surgical treatment. J Thorac Cardiovasc Surg. 1986;92:981–8.

  5. 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;54:1159–64.

    Article  CAS  Google Scholar 

  6. Park CK, Jheon S. Results of surgical treatment for pulmonary aspergilloma. Eur J Cardiothorac Surg. 2002;21:918–23.

  7. Brik A, Salem AM, Kamal AR, et al. Surgical outcome of pulmonary aspergilloma. Eur J Cardiothorac Surg. 2008;34:882–5.

  8. Al-Kattan K, Ashour M, Hajjar W, El Din MS, Fouda M, Al Bakry A. Surgery for pulmonary aspergilloma in post-tuberculous vs. immuno-compromised patients. Eur J Cardiothorac Surg. 2001;20:728–33.

  9. Mohapatra B, Sivakumar P, Bhattacharya S, Dutta S. Surgical treatment of pulmonary aspergillosis: a single center experience. Lung India. 2016;33:9–13.

    Article  Google Scholar 

  10. Ong CWM, Elkington PT, Friedland JS. Tuberculosis, pulmonary cavitation, and matrix metalloproteinases. Am J Respir Crit Care Med. 2014;190:9–18.

  11. Doğru D, Nik-Ain A, Kiper N, et al. Bronchiectasis: the consequence of late diagnosis in chronic respiratory symptoms. J Trop Pediatr. 2005;51:362–5.

  12. Crimi C, Ferri S, Campisi R, Crimi N. The link between asthma and bronchiectasis: state of the art. Respiration. 2020;99:463–76.

  13. Reichenberger F, Habicht J, Matt P, et al. Diagnostic yield of bronchoscopy in histologically proven invasive pulmonary aspergillosis. Bone Marrow Transplant. 1999;24:1195–9.

  14. Kumar A, Asaf BB, Puri HV, et al. Video-assisted thoracoscopic surgery for pulmonary aspergilloma. Lung India. 2017;34:318–23.

  15. El Hammoumi MM, Slaoui O, El Oueriachi F, Kabiri EH. Lung resection in pulmonary aspergilloma: experience of a Moroccan center. BMC Surg. 2015;15:114.

    Article  Google Scholar 

  16. Seok H, Jeon JH, Oh KH, et al. Characteristics of residual lymph nodes after six months of antituberculous therapy in HIV-negative individuals with cervical tuberculous lymphadenitis. BMC Infect Dis. 2019;19:867.

    Article  Google Scholar 

  17. Kirsh MM, Rotman H, Behrendt DM, Orringer MB, Sloan H. Complications of pulmonary resection. Ann Thorac Surg. 1975;20:215–36.

    Article  CAS  Google Scholar 

  18. Maturu VN, Agarwal R. Itraconazole in chronic pulmonary aspergillosis: in whom, for how long, and at what dose? Lung India. 2015;32:309–12.

  19. Jenks JD, Hoenigl M. Treatment of Aspergillosis. J Fungi (Basel). 2018;4:98.

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Mallampati Sameer, Nishok David, Vinay Murahari Rao, Santhosh Regini Benjamin, Birla Roy Gnanamuthu, Aamir Mohammad & Rijoy Kolakkada Panakkada

Authors
  1. Mallampati Sameer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nishok David
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vinay Murahari Rao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Santhosh Regini Benjamin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Birla Roy Gnanamuthu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aamir Mohammad
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rijoy Kolakkada Panakkada
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Santhosh Regini Benjamin, Mallampati Sameer, and Nishok David. The first draft of the manuscript was written by Santhosh Regini Benjamin and all authors commented on previous versions of the manuscript. The final manuscript was written by Santhosh Regini Benjamin and Birla Roy Gnanamuthu. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Santhosh Regini Benjamin.

Ethics declarations

Ethics approval

The approval of the institutional review board has been obtained.

Informed consent

Written consent for studies and publication were obtained from the patients prior to the surgery.

Statement of human and animal rights

The study has been performed in accordance with the ethical standards as laid down in the 1964 declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sameer, M., David, N., Rao, V.M. et al. Surgical management of pulmonary aspergilloma—12 years’ experience from a tertiary care centre in India. Indian J Thorac Cardiovasc Surg 37, 402–410 (2021). https://doi.org/10.1007/s12055-021-01181-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-021-01181-6

Keywords

Search

Navigation