SURGICAL MANAGEMENT OF PULMONARY ASPERGILLOMA - AN INSTITUTIONAL STUDY IN STANLEY HOSPITAL FROM 2012 TO 2018

Prof.Dr.Dhamodaran.K; Dr.Natramizh.K

Volume : VIII, Issue : II, February - 2019

SURGICAL MANAGEMENT OF PULMONARY ASPERGILLOMA - AN INSTITUTIONAL STUDY IN STANLEY HOSPITAL FROM 2012 TO 2018

Prof. Dr. Dhamodaran. K, Dr. Natramizh. K

Abstract :

Background Aspergillus are molds that are found in organic matter. Most of the human infections are caused by Aspergillus fumigatus , primarily affecting the lungs. Patients who are severely immunocompromised are most susceptible to these fungal infections. In India, where tuberculosis is endemic mostly in the rural areas, patients with pre existing cavities develops aspergilloma. These form a fungal ball which causes hemoptysis by erosion of onchial vessels. Surgery remains the curative form of management. Methods Clinical presentation, Radiological investigations, Surgical techniques, Post operative outcome, Histopathological features, and Follow up of 12 cases of Pulmonary Aspergilloma treated surgically were studied prospectively from 2012 to 2018 at Stanley Hospital, Chennai. Results There were 9 male (75%) and 3 female ( 25%) patients in this study group. Mean age of the study group was 39.7 years. All the patients in this series had complex aspergilloma. 11 patients (91.66% ) in this series had Tuberculosis. All these patients hailed from rural areas belonging to low socio economic status. The mean duration of period from first diagnosis of Tuberculosis to the presentation of aspergilloma was 4.1 years. The main presenting symptom was Hemoptysis in 91% of cases. Patients were investigated with chest X-Ray and Computed Tomography scan. Air crescent sign was characteristic in most of the cases. Right upper lobe was involved in 66.66% of patients and Left upper lobe was involved in 33.33% of patients. Thoracotomy with lung resection was done in these patients . Lobectomy was done in 9 patients(75%), Segmentectomy was done in 2 patients (16.6%) and Pneumonectomy was done in 1 patient (8.33%). Non fatal post operative complications occurred in 25% of the patients. The average period of follow up was 25.5 months, in which there was no mortality and no further seeding in same or opposite side and no symptoms suggestive of aspergilloma. Conclusions Surgery involving aggressive resection remains the permanent effective curative management of pulmonary aspergilloma and to provide the patients effective outcome