Pleuropulmonary Aspergilloma: Clinical Spectrum and Results of Surgical Treatment Gilbert Massard, MD, Norbert Roeslin, MD, Jean-Marie Wihlm, MD, Pascal Dumont, MD, Jean-Paul Witz, MD, and Georges Morand, MD Department of Thoracic Surgery, University Hospital of Strasbourg, Strasbourg, France
From 1974 to 1991, 77 patients were admitted for pulmonary (55), pleural (16), or bronchial (6) aspergilloma. About 50% were asymptomatic. Sixty-three underwent operation. Pulmonary aspergillomas were operated on for therapeutic need in 26 and on principle in 18; the procedures were 28 lobar or segmental resections, 10 thoracoplasties, and 5 pleuropneumonectomies (1patient had exploration only). Pleural aspergillosis was treated by operation on principle in 5 and for therapeutic need in 8 patients; 10 thoracoplasties, 1 attempt at pleuropneumonectomy, and 2 decortications were performed. All six bronchial lesions were operated on as a rule. Overall postoperative mortality was 9.5%. Major complications were bleeding (n = 37), pleural space problems (n = 24),
respiratory failure (n = 6), and postpneumonectomy empyema (n = 4). All patients with pleural disease experienced complications. The outcome was better after lobar or segmental resection than after thoracoplasty (mortality, 6% versus 15%). Asymptomatic and nonsequellary pulmonary or bronchial aspergilloma also had an improved outcome. We conclude that operation is at low risk in pulmonary or bronchial locations in asymptomatic patients and in the absence of sequellae; the risk is high in symptomatic patients for whom operation is the only definite treatment. Pleuropneumonectomy should be avoided. Only symptomatic pleural aspergilloma should be operated on. (Ann Thorac Surg 1992;54:1159-64)
S
weight estimated with the Lorentz formula), respiratory function (percentage of vital capacity and of forced expiratory volume in 1 second/forced vital capacity), and serodiagnosis (number of precipitations on immunoelectrophoresis). For each patient, we noted the underlying disease, the diagnostic circumstances, radiologic findings, and the reasons for surgical decision. Postoperative outcome was assessed for mortality and major nonfatal complications (hemorrage, pleural space problems, and respiratory distress). A postoperative hospital stay exceeding 30 days was noted as an objective indicator of major complications. Bleeding was evaluated through the summed operative blood loss and postoperative drainage of the first 24 hours; we considered as major bleeding any quantity exceeding 1,500 mL. Pleural space problems included prolonged air leaks, secondary pneumothoraces, and postoperative aspergillus empyema. Respiratory failure was defined by the necessity of artificial ventilation beyond the first 24 hours. The analysis was conducted considering first the location of aspergilloma and second the type of surgical procedure. A further comparative study was made on the basis of subgroups created within the operated pulmonary and bronchial aspergillomas (total = 50): operation on principle in asymptomatic patients (26) versus therapeutic need (24), and parenchymal sequelae (40) versus absence of underlying disease (10). These subgroups were compared for nutritional status, respiratory function, and postoperative outcome. Pleural aspergillosis was ex-
urgical decision-making for pulmonary or pleural aspergilloma is one of the major dilemmas shared by the chest physician and the thoracic surgeon. The former is unable, even with the most sophisticated investigations, to predict cataclysmic hemoptysis. The latter has the means of a definite cure; however, operation frequently is technically difficult, and postoperative outcome is known to have a high morbidity and mortality rate. The purpose of our review was (1) to compare the different locations of aspergilloma (ie, pulmonary, pleural or bronchial), (2) to assess postoperative complications, and (3) to define high-risk and low-risk subgroups.
Material and Methods Patients We reviewed records of 77 patients admitted with pleuropulmonary aspergilloma from 1974 through 1991. There were 57 male and 20 female patients, with a mean age of 49 years (range, 16 to 75 years). Three groups were defined according to the location of the disease: pulmonary aspergilloma (55 patients), pleural aspergilloma (16 patients), and bronchial aspergilloma (6 patients).
Methods The three groups of patients were compared with respect to mean age, nutritional status (percentage of the ideal Accepted for publication April 6, 1992. Address reprint requests to Dr Massard, Service de Chirurgie Thoracique, Hospices Civils, CHRU, F-67091 Strasbourg-Cedex, France.
0 1992 by The Society of Thoracic Surgeons
0003-4975/92/$5.00
1160
MASSARD ET AL OPERATION FOR ASPERGlLLOMA
Ann Thorac Surg 1992;54:1159-64
Table 1 . General Variables and Location of Aspergilloma“ Pulmonary Variable Age (Y) Nutritionb VC‘ FEV,/VC‘ Serodiagnosisd
(n
=
48.2 st 86.2 t 77.5 2 60.4 2 6.3
*
Pleural
55)
(n
14.2 13.2 23.9 16.9 3.9
=
16)
* 13.6 12.1 * 16.2
54.6 83.8 2 65.5 67.8 7.1
* 14.1 * 3.3
Bronchial (n
=
6)
40.2 2 17.4 111.8 t 26.9 97.5 14.5 78.3 7.9 2.6 st 1.7
*
Statistics
p Value
t Value
2.07 4.15 2.77 2.48
C0.05
From 1974 to 1991, 77 patients were admitted for pulmonary (55), pleural (16), or bronchial (6) aspergilloma. About 50% were asymptomatic. Sixty-three underwent operation. Pulmonary aspergillomas were operated on for therapeutic need in 26 and on principle in 18; the procedures were 28 lobar or segmental resections, 10 thoracoplasties, and 5 pleuropneumonectomies (1patient had exploration only). Pleural aspergillosis was treated by operation on principle in 5 and for therapeutic need in 8 patients; 10 thoracoplasties, 1 attempt at pleuropneumonectomy, and 2 decortications were performed. All six bronchial lesions were operated on as a rule. Overall postoperative mortality was 9.5%. Major complications were bleeding (n = 37), pleural space problems (n = 24),
respiratory failure (n = 6), and postpneumonectomy empyema (n = 4). All patients with pleural disease experienced complications. The outcome was better after lobar or segmental resection than after thoracoplasty (mortality, 6% versus 15%). Asymptomatic and nonsequellary pulmonary or bronchial aspergilloma also had an improved outcome. We conclude that operation is at low risk in pulmonary or bronchial locations in asymptomatic patients and in the absence of sequellae; the risk is high in symptomatic patients for whom operation is the only definite treatment. Pleuropneumonectomy should be avoided. Only symptomatic pleural aspergilloma should be operated on. (Ann Thorac Surg 1992;54:1159-64)
S
weight estimated with the Lorentz formula), respiratory function (percentage of vital capacity and of forced expiratory volume in 1 second/forced vital capacity), and serodiagnosis (number of precipitations on immunoelectrophoresis). For each patient, we noted the underlying disease, the diagnostic circumstances, radiologic findings, and the reasons for surgical decision. Postoperative outcome was assessed for mortality and major nonfatal complications (hemorrage, pleural space problems, and respiratory distress). A postoperative hospital stay exceeding 30 days was noted as an objective indicator of major complications. Bleeding was evaluated through the summed operative blood loss and postoperative drainage of the first 24 hours; we considered as major bleeding any quantity exceeding 1,500 mL. Pleural space problems included prolonged air leaks, secondary pneumothoraces, and postoperative aspergillus empyema. Respiratory failure was defined by the necessity of artificial ventilation beyond the first 24 hours. The analysis was conducted considering first the location of aspergilloma and second the type of surgical procedure. A further comparative study was made on the basis of subgroups created within the operated pulmonary and bronchial aspergillomas (total = 50): operation on principle in asymptomatic patients (26) versus therapeutic need (24), and parenchymal sequelae (40) versus absence of underlying disease (10). These subgroups were compared for nutritional status, respiratory function, and postoperative outcome. Pleural aspergillosis was ex-
urgical decision-making for pulmonary or pleural aspergilloma is one of the major dilemmas shared by the chest physician and the thoracic surgeon. The former is unable, even with the most sophisticated investigations, to predict cataclysmic hemoptysis. The latter has the means of a definite cure; however, operation frequently is technically difficult, and postoperative outcome is known to have a high morbidity and mortality rate. The purpose of our review was (1) to compare the different locations of aspergilloma (ie, pulmonary, pleural or bronchial), (2) to assess postoperative complications, and (3) to define high-risk and low-risk subgroups.
Material and Methods Patients We reviewed records of 77 patients admitted with pleuropulmonary aspergilloma from 1974 through 1991. There were 57 male and 20 female patients, with a mean age of 49 years (range, 16 to 75 years). Three groups were defined according to the location of the disease: pulmonary aspergilloma (55 patients), pleural aspergilloma (16 patients), and bronchial aspergilloma (6 patients).
Methods The three groups of patients were compared with respect to mean age, nutritional status (percentage of the ideal Accepted for publication April 6, 1992. Address reprint requests to Dr Massard, Service de Chirurgie Thoracique, Hospices Civils, CHRU, F-67091 Strasbourg-Cedex, France.
0 1992 by The Society of Thoracic Surgeons
0003-4975/92/$5.00
1160
MASSARD ET AL OPERATION FOR ASPERGlLLOMA
Ann Thorac Surg 1992;54:1159-64
Table 1 . General Variables and Location of Aspergilloma“ Pulmonary Variable Age (Y) Nutritionb VC‘ FEV,/VC‘ Serodiagnosisd
(n
=
48.2 st 86.2 t 77.5 2 60.4 2 6.3
*
Pleural
55)
(n
14.2 13.2 23.9 16.9 3.9
=
16)
* 13.6 12.1 * 16.2
54.6 83.8 2 65.5 67.8 7.1
* 14.1 * 3.3
Bronchial (n
=
6)
40.2 2 17.4 111.8 t 26.9 97.5 14.5 78.3 7.9 2.6 st 1.7
*
Statistics
p Value
t Value
2.07 4.15 2.77 2.48
C0.05
![[Results of surgical treatment for pulmonary aspergilloma].](/assets/img/hold.png)
