This investigation is designed to illustrate the clinical features & preoperative diagnosis, surgical role in the management of pulmonary aspergilloma, & compare with the previous study.
We reviewed 42 cases of surgically treated pulmonary aspergillosis from Jan. 1984 to July 1992. The peak age incidence laid in the 2nd & 3rd decade of 25 cases(59.5%). The 41 cases(97.6%) had a history of treatment with anti-tuberculous drugs
under
impression of pulmonary tuberculosis. The most common complaint was hemoptysis in 28 cases(66.7%) The 21 cases showed so called "Air-meniscus sign" on the preoperative chest X-ray. As a preoperative diagnostic modality, the positivity was 30.0%,
57.8%,
88.5% on the fungus culture of sputum for Aspergillus, Chest CT, serum immunodiffusion test for A fumigatus, respectively. The 37 cases (88.1%) can be diagnosed as pulmonary aspergillosis preoperatively by any diagnostic method. The anatomical
location
of aspergilloma was mainly upper lobe in 17 case(40.5%) & the majority of cases were managed by lobectomy. The postoperative pathologic findings showed that 18 cases(41.0%) were combined with tuberculosis & 15 cases(34.1%) were not combined with
any
other disease(Primary Aspergillosis ). The 6 cases showed postoperative empyema including 4 cases of bronchopleural fistula, 3 cases showed postoperative bleeding. One cases was died postoperative due to respiratory failure.
In conclusion, when the patient who has longstanding history fo pulmonary tuberculosis & hemoptysis, must be suspected fungal super infection. The resectional surgery is the treatment of choice for symptomatic localized disease. And compare with
the
previous study, preop. Chest CT & immunodiffusion test were more commonly available & showed high positivity.
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