Chest
Volume 143, Issue 1, January 2013, Pages 238-241
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Selected Reports
Bronchoscopic Removal of a Large Intracavitary Pulmonary Aspergilloma

https://doi.org/10.1378/chest.12-0400Get rights and content

Pulmonary aspergilloma is a chronic fungal infection that has a high mortality when hemoptysis occurs. Surgery is the treatment of choice, but patients often have severe physiologic impairment putting them at risk for significant surgical morbidity and mortality. We present the case of a 63-year-old woman with a large aspergilloma, unfit for surgery due to medical reasons. The aspergilloma was enlarging, with progression of the patient's symptoms of anorexia, cough, chest discomfort, and hemoptysis. Bronchoscopy revealed an airway leading into a cavity with a large fungal ball. Biopsy confirmed Aspergillus fumigatus. Using flexible and rigid bronchoscopy, the aspergilloma was mechanically removed. Eighteen months later the patient reported no hemoptysis, reduced pain and cough, significant weight gain, and improved appetite, with no recurrence of the aspergilloma on repeat imaging. To our knowledge, this is the first reported case of bronchoscopic removal of a large cavitary aspergilloma. This important new treatment modality provides a viable alternative therapy for this potentially life-threatening problem.

Section snippets

Case Report

A 63-year-old woman with chronic obstructive pulmonary disease presented with a large (6.5 cm × 5.0 cm) aspergilloma (culture of BAL was positive for Aspergillus). Over the course of 3 years, the aspergilloma increased in size (Figs 1, 2), and the patient's symptoms of anorexia, weight loss, productive cough, chest discomfort, and hemoptysis progressed despite 12 months of itraconazole, followed by 2 months of voriconazole therapy. She was deemed unfit for surgery due to the risk of

Discussion

Intracavitary pulmonary aspergilloma is a potentially life-threatening problem characterized by mycelial growth in a preexisting lung cavity that is difficult to treat without surgical therapy, which is the accepted treatment of choice in appropriately selected patients. It does not respond to antifungal agents alone (including IV amphotericin B14), and mixed success has been obtained with inhaled, intracavitary, and endobronchial instillations of antifungal agents.4, 15, 16 Bronchial artery

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Other contributions: This work was performed out of the Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada.

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