Treatment of hemoptysis in patients with cavitary aspergilloma of the lung: value of percutaneous instillation of amphotericin B.

OBJECTIVE

Surgery has been the primary choice of treatment for cavitary aspergillomas of the lung, but it is associated with relatively high morbidity and mortality. The effectiveness of percutaneous intracavitary instillation of an antifungal agent in seven patients with hemoptysis caused by cavitary aspergilloma was evaluated.

SUBJECTS AND METHODS

All patients had hemoptysis associated with a cavitary pulmonary aspergilloma. In four patients who had aspergillomas without lung interposed between the cavity and the chest wall, 50 mg of amphotericin B in 10 ml of 5% dextrose in water and then 8 mg of bromhexine (a mucolytic agent) mixed with 10 ml of normal saline were instilled into the cavity through an 8-French catheter daily for 15 days. In three patients who had lung interposed between the cavity and the chest wall, the treatment was administered twice at 3-day intervals through a 20-gauge needle. The presence or absence of hemoptysis was recorded after each instillation of amphotericin B, and the size of aspergilloma was assessed with follow-up radiographs.

RESULTS

Hemoptysis ceased within 5 days after instillation of amphotericin B in all patients. In the four patients treated through a catheter, the aspergillomas resolved completely in three patients and resolved partially in one. In the three patients treated through a fine needle, the aspergillomas resolved partially. Mild hemoptysis during the procedure, a small pneumothorax, and subcutaneous emphysema occurred in one patient each.

CONCLUSION

Our results suggest that percutaneous intracavitary instillation of amphotericin B is a safe and effective method of treating hemoptysis caused by aspergillomas.