Aspergillomas and lung fibrosis — a review of cases in a general hospital

Summary

IN a review of eleven patients with aspergilloma attending St. Vincent’s Hospital between 1973 and 1984 sarcoid osis was the commonest predisposing disease (six patients) whereas cavitary tuberculosis, previously the most frequently associated condition, was present in only two patients. All patients had a combined restrictive-obstructive pulmonary deficit with mean values for FVC, FEV, and DLCO being 49%, 35% and 46% of predicted respectively. Life threatening haemoptysis was the most significant complication, occurring in six of eleven patients. In only two of these patients was lung function sufficiently adequate to permit surgical resection and both are alive 5 and 9 years respectively following the procedure. Four patients precluded from surgery because of prohibitive lung function had emergency bronchial arteriography performed with a vitw to arterial embolisation. This was successfully achieved in three patients with prompt cessation of active major haemoptysis, but could not be performed in a fourth because of an arterial anomaly. However there were no long term survivors in this latter non-surgical group. Finally, in five untreated patients observed over a mean period of three years, no major complications developed, despite enlargement of the fungus ball in three individuals. This study demonstrates a changing pattern of underlying disease in patients with aspergilloma and illutrates the usefulness of emergency arterial embolisation in the short term management of life threatening haemoptysis.