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The Annals of Thoracic Surgery, Vol 54, 1159-1164, Copyright © 1992 by The Society of Thoracic Surgeons
G Massard, N Roeslin, JM Wihlm, P Dumont, JP Witz and G Morand
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 (1 patient 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.
ARTICLES
Pleuropulmonary aspergilloma: clinical spectrum and results of surgical treatment
Department of Thoracic Surgery, University Hospital of Strasbourg, France.
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