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Original Articles: General Thoracic

Surgical Management of Pulmonary and Mediastinal Sequelae of Histoplasmosis: A Challenging Spectrum

^a Department of Surgery, Division of Cardiothoracic Surgery, Henry Ford Hospital, Detroit, Michigan
^b Department of Medicine, Division of Pulmonary Medicine, Indiana University School of Medicine, Indianapolis, Indiana
^c Department of Surgery, Cardiothoracic Division, Indiana University School of Medicine, Indianapolis, Indiana

Accepted for publication April 13, 2009.

^_* Address correspondence to Dr Hammoud, Division of Cardiothoracic Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 (Email: zhammou1{at}hfhs.org).

Background: Histoplasmosis may result in a spectrum of complications that require thoracic surgical intervention. We reviewed our 17-year experience in the management of histoplasmosis to determine outcomes as well as gain insight into the distribution of complications requiring surgical intervention.

Methods: The hospital records of patients who underwent surgical treatment for complications related to histoplasmosis from 1991 to 2008 were reviewed. Based on the predominant presentation, patients were categorized with complications secondary to broncholithiasis, granulomatous disease, or fibrosing mediastinitis. Patients who underwent diagnostic surgery and were found to have histoplasmosis were excluded.

Results: Of the 49 patients who underwent surgery for histoplasmosis-related complications, 27 (55%) had granulomatous disease, 13 (27%) had broncholithiasis, and 9 (18%) had fibrosing mediastinitis. The most common clinical presentations were recurrent pneumonia (n = 16) and hemoptysis (n = 13); less common presentations included dysphagia (n = 3) and superior vena cava syndrome (n = 1). Two patients required cardiopulmonary bypass for resection; 1 of these died postoperatively (series mortality 2%). Seven patients (14%) had complications. Relief of symptoms was achieved in all surviving patients.

Conclusions: Complications of histoplasmosis requiring thoracic surgical intervention are diverse with pulmonary complications predominating. Although surgically challenging, excellent short- and long-term outcomes may be expected.

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Ann. Thorac. Surg. 2009 88: 404. [Extract] [Full Text] [PDF]

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				S. L. Meyerson Invited commentary. Ann. Thorac. Surg., August 1, 2009; 88(2): 404 - 404. [Full Text] [PDF]