Pulmonary aspergillus infection invading the pleura.

During a 10-year-period, six patients with non-postoperative aspergillus infection of the pleura were seen. In all patients a pulmonary aspergillus infection had been present for some years. The fungus invaded the pleura, causing a bronchopleural fistula and a cavity in the pleural space. A prerequisite for the pleural aspergillosis was that the lung and pleura were previously damaged, usually by therapeutic pneumothorax for active tuberculosis some decades earlier. The fungus can cause destruction of the lung and death of the patient from the chronic infection unless treated. The best treatment is early excision of the pleura with resection of the upper lobe or if necessary the whole lung. To reduce the risk of postoperative aspergillus empyema, the patient should be treated with antifungal agents before and after operation. In inoperable patients, local antifungal treatment may clear the infection but is not always effective.