Surgical management of pulmonary aspergilloma

Abstract

Pulmonary aspergillomas occur due to the aspergillus fungus colonising pre-existing cavities within the lungs of patients with underlying lung pathology or in those who are immunosuppressed. Their clinical presentation can be variable and they often present to the surgical clinic after patients develop haemoptysis. This haemoptysis can vary from mild bleeds to catastrophic life-threatening haemorrhage. Surgery for patients with aspergillomas historically carried a high morbidity and mortality impact and so the role of surgery was usually saved for patients presenting with severe haemoptysis. In recent years further research has demonstrated a reduction in the morbidity and mortality impact of surgery and therefore the question has been raised whether surgical intervention should be offered at an earlier stage. Surgery for pulmonary aspergilloma is technically challenging and does still carry a marked morbidity and mortality risk. Although these risks have reduced in recent years, surgery should still be reserved for symptomatic patients with a significant risk of further bleeding. A multi-disciplinary framework is crucial to offer best risk; benefit assessment and discussion for this high-risk patient group. This article will describe the natural history and presentations of aspergillomas, the indications and types of surgery as well as a multi-disciplinary approach to patient assessment.