Aspergilloma - Presentation and management: Our experience

Abstract

Received 09 November 2017 Revised 12 January 2018 Accepted 20 January 2018 Early online 27 January 2018 Print 31 January 2018 In India where tuberculosis (TB) is rampant (second highest in Asia), post tuberculosis patient presenting with aspergilloma is common in our scenario. The current study was done to emphasize the need of early and aggressive surgical management for aspergilloma. This study included 26 cases of aspergilloma, over period of 4 years between 2013 and 2017 in TB Hospital Erranum, Hyderabad in the of Department of Cardio-thoracic Surgery. Of the 26 cases considered for the study there were 18 males and 8 females. 21 cases were diagnosed of TB, 4 cases of bronchiectasis and 1 case there was no obvious cause (detected on X ray as incidental finding). Hemoptysis was the most common presentation found in 20 cases, 4 cases presented with excessive sputum but no hemoptysis, 1 case diagnosed of TB did not present with hemoptysis or sputum production and 1 case was asymptomatic (incidentally detected on X-ray). All patients were taken up for surgical management via thoracotomy of which 21 cases underwent upper lobectomy (14 right, 7 left), 1 wedge resection, 1 pneumonectomy (left side). Post operatively 4 patients had bleeding, of which one was reopened for exploration and hemostasis. 1 patient developed empyema, 1 developed respiratory infection, 1 wound infection and one broncho plural fistula. One patient succumbed to death. To conclude, the most acceptable treatment of choice was found to be surgical intervention in the form of lobectomy, wedge resection or pneumonectomy. Early and aggressive intervention is the key for lower mortality and better survival. Corresponding author