[Role of surgery in the treatment of pulmonary aspergillosis].

INTRODUCTION

This article reviews the different forms of pulmonary disease caused by aspergillus and discusses the possible surgical treatments. The most well known is the classic aspergilloma which develops as a fungal ball in the centre of a pre-existing pulmonary cavity.

STATE OF KNOWLEDGE

One can distinguish simple (few symptoms, thin walled cavity without immediate complications) and complex forms (patient generally unwell, thick cavity, complications). In the complex form, surgical intervention must be considered as a last resort. In the simple form, surgery is relatively benign and prevents disease progression. Pleural aspergillosis can occur, usually following the surgical removal of a cavity either in the short or medium term. Given the loss of lung parenchyma thoracoplasty is often the only option.

OUTLINES

Two different scenarios occur in acute invasive aspergillosis where surgery may be indicated: firstly, surgery can be considered in the event of haemoptysis related to vascular erosion; secondly, resection of mycotic sequestrations before intensification or resumption of therapy may prevent a relapse. Semi-invasive aspergillosis usually occurs in territories of post-radiation fibrosis: after a phase of invasion equivalent to a lobar pneumonia, a secondary cavity appears containing a small fungal ball. Thoracoplasty is often the only surgical option. Ulcerating tracheobronchial aspergillosis has been observed following (cardio-) pulmonary transplant and this may progress to a characteristic invasive aspergillosis.

CONCLUSIONS

Finally, rare observations of parietal aspergillosis could be treated by surgical resection and associated with systemic antifungal therapy. Optimum management of these patients requires a multidisciplinary approach.