Pulmonary aspergilloma: surgical approch

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Pulmonary aspergilloma is a fungal infection resulting from the growth of mycelial filaments within an existing pulmonary cavity. Surgical resection is the treatment of choice, mostly with anatomical resection. Methods: It’s a retrospective study including patients who underwent surgery for pulmonary aspergilloma between 2020 and 2024. Results: We collected 12 patients (9 men/3 women) with a mean age of 51 years. Five patients had a prior history of pulmonary tuberculosis. One patient had complicated pulmonary hydatid cyst and one patient had medullary aplasia complicated by pulmonary and splenic aspergillosis. The symptomatology was hemoptysis in 11 cases. Radiological investigations revealed a cavitary pulmonary lesion in all cases with a “fungal ball” appearance in 5 cases. Aspergillus serology was positive in 5 cases. Preoperative antifungal therapy was given for 1 to 2 months in 5 patients. All patients underwent surgical intervention via a posterolateral thoracotomy. It consists on lobectomy (n=9), bilobectomy (n=1), segmentectomy (n=1) and perikystectomy (n=1). Postoperative course was uneventful in 8 cases. Two patients presented postoperative pneumonia that responded well to antibiotics. One patient had a postoperative pyothorax requiring surgical reintervention while another had arrhythmia postoperatively. No mortality was observed in our serie. Conclusion: Surgical treatment of pulmonary aspergilloma depends on factors such as the severity of symptoms, the patient's respiratory function, the condition of the underlying lung, and the particular type of aspergilloma. Meanwhile, antifungal therapy may be combined with surgical intervention.

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