Surgical Management of Invasive Pulmonary Aspergillosis in Hemtologic Malignancy Patients: Report of 2 cases / 대한흉부외과학회지

The mortality rate of the invasive pulmonary aspergillosis to be able to developed during chemotherapy induced myleosuppressionin is high in hematologic malignancy patients despite antifungal treatment. Effective antifungal treatment combined with operation can decrease the mortaligy rate of the invasive pulmonary aspergillosis. Recently, we experienced the successful management of the two cases of invasive pulmonary aspergillosis in acute lymphoblastic leukemia through effective antifungal treatment and surgical resection. We report this cases with review of literature.

Pulmonary Resection for Invasive Pulmonary Aspergillosis in Hematological Malignancy Patients / 대한흉부외과학회지

BACKGROUND: Invasive pulmonary aspergillosis, a frequent fungal infection in immunocompromised patients, is known to have a poor prognosis despite the use of antifungal therapy in leukemic patients. We studied the outcome of surgical resection of invasive pulmonary aspergillosis where bleeding tendency, localized recurrence of infection, and incidence could be reduced. MATERIAL AND METHOD: We retrospectively reviewed 14 patients with a hematological malignancy where invasive pulmonary aspergillosis was diagnosed during the 10 years between 1998 and 2007. From the medical records, we reviewed the type and treatment of the hematological malignancy, including the diagnostic methods of invasive pulmonary aspergillosis, the preoperative hematological conditions and their management, and the surgical methods and records. We also analyzed the development of postoperative complications and patient mortality, the recurrence of postoperative invasive pulmonary aspergillosis, and if the patients had a bone marrow transplant. RESULT: Fourteen patients with invasive pulmonary aspergillosis and a hematological malignancy underwent a pulmonary lobectomy. One patient had a complication of bronchopleural fistula, but there were no other serious complications such as bleeding or wound infection, and none of the patients died postoperatively. CONCLUSION: We have shown that pulmonary lobectomy is a safe and effective therapy for invasive pulmonary aspergillosis in patients with hematological malignancies that allow further treatment of the hematological malignancy.

Invasive Pulmonary Aspergillosis Invaded to Thoracic Vertebra in a Immunocompetent Host: A case report / 대한흉부외과학회지

Pulmonary aspergillosis is the most common disease of fungal infection and has lower infectivity. Pulmonary aspergillosis is classified by aspergilloma, bronchopulmonary aspergillosis, necrotic and invasive aspergillosis. Invasive aspergillosis is found in immune compromised host, immunosuppressive treatment after organ transplantation, anticancerous chemotherapy, blood abnormality, AIDS patients etc. We reported a case of invasive aspergillosis in an immunocompetent host, with review of literatures.

Necrotizing Bronchial Aspergillosis: A case report / 대한흉부외과학회지

Necrotizing bronchial aspergillosis usually occurs in the immumocompromised host. Aspergillus invades bronchial epithelium and forms endobronchial mass or endobronchial stenosis. A 78-year-old male patient with diabetus mellitus complaining of dyspnea and cough was admitted to our hospital. Plain chest X-ray and chest computed tomogram showed a large endobronchial mass and total collapse of left upper lobe of the lung. Bronchoscopic biopsy of the endobronchial mass revealed chronic inflammation. To confirm the endobronchial mass, we performed sleeve lobectomy of left upper lobe of the lung. Histologically the mass was diagnosed as necrotizing bronchial aspergillosis. We report a case of necrotizing bronchial aspergillosis in an elderly man who has diabetus mellitus with review of the literature.

Aspergillosis infection in lung transplant recipients (4 cases report and review of the literature) / 中华胸心血管外科杂志

Objective To discuss the prophylaxis, surveillance, and therapy on the aspergillus colonization and infection in lung transplant recipients. Methods From Jan 2003 to Sep 2004, single lung transplantation was performed in 6 patients. In 4 patients there was presence of positive aspergillus cultures from sputum after operation. Results Of these, two patients were symptomless, though treated by Itraconazole for two months. The third one has symptomatic bronchial stenosis, bronchomalacia and saprophytic colonization in the first postopearative month, which was proved by bronchoscopic biopsy and cured by stenting. The last one with invasive, disseminated pneumonia duo to aspergillus was cured after six weeks by itraconazole and aerosolized amphotericin B. Conclusion Antifungal prophylaxis with itraconazole and aerosolized amphotericin B prevent fungal infection during the early postoperative period of lung transplantation.

Surgical analysis of pulmonary aspergilloma / 대한흉부외과학회지

BACKGROUND: Pulmonary aspergilloma is a potential life-threatening disease resulting from massive hemoptysis. Pulmonary aspergilloma has been treated surgically for many years, however, it has also had higher risk of mortality and complication rate. The purpose of this study is to analyze the operative methods and the types of complications. MATERIAL AND METHOD: Sixty patients who underwent surgical resection for pulmonary their medical reconrds. RESULT: The mean age was 46.3+/-13.4 years(range 20 to 76 years). The most common clinical presentation was hemoptysis which occurred in 48 patients(80%). Pulmonary tuberculosis was the most common pre-existing disease, occurri9ng in 28 patients(46.7%). The other associated lung diseases were bronchiectasis(n=11), silicosis(n=2), and chronic pnumonia(n=1). Operative proceudres wer lobectomy in 35 patients, pneumonectomy in 6, segmentectomy in 5, lobectomy and thoracoplasty in 3, segmentectomy and thoracopasty in 1, and cavernostomy in 10. The operative mortality was 6%(n=3) in lung resection patients but 0% in cavernostomy patients. The most common complications were prolonged air leakage, wound infection and postoperative bleeding. CONCLUSIONS: In most cases of pulmonary aspergilloma surgical resectin remains the only effective therapy. However, cavernostomy may be more effective for pulmonary aspergilloma patients with decreased pulmonary functions and for patients with high risk for lung resection.

Large aspergilloma cavity treated by Cavernostomy and ometal, muscle flaps: A case report / 대한흉부외과학회지

Pulmonary aspergilloma is potentially a life threatening disease resulting from the colonization of lung cavities by Aspergillus fumigatus. A case is reported: a 43-year-old man with symtomatic cavitary aspergilloma presenting with severe productive coughing, hemoptysis, occasional fever, and chilling. On preoperative plain chest radiograph and CT scan, we could find a rounded irregular opacity in a large pulmonary cavity. He received 2 separate operations for therapeutic need. At the first opertion, we performed cavernostomy and thoracoplasty because of severe pleural adhesions, tearing of cavity wall, and high risk of respiratory insufficiency. At the second operation, we performed myoplasty and omentoplasty for closure of remaining air space and complete wrapping of the BPF site. All symptoms of dyspnea and hemoptysis have since resolved. We believed that in the high risk patients who have severe respiratory symptoms, such as in aspergilloma and open cavity with a risk of respiratory insufficiency, cavernostomy followed by myoplasty or omentoplasty should be recommended.