[Emergency lung resections for invasive aspergillosis in neutropenic patients].
Mortality due to Invasive Pulmonary Aspergillosis (IPA) remains high in neutropenic patients due to pulmonary haemorrhage. The aim of this study was to evaluate the emergency surgical management of IPA. Seven neutropenic patients, with a mean age of 47 years (range: 30-64) (4 women and 3 men) were treated for (6 cases) acute leukaemia one Myeloma (1 case). Presumptive diagnosis of IPA was based on: Halo sign (n = 6) or air-crescent sign (n = 1) on CT scan, positive serology (n = 4), positive antigenemia (n = 3) and positive broncho-alveolar lavage (n = 1). In 2 cases, IPA diagnosis was only based on CT scan. In all cases, aspergillosis lesions were located near the left (n = 5) or right (n = 2) pulmonary artery. The type of pulmonary resection was: left superior lobectomy in 3 cases, left superior lobectomy and Fowler's segmentectomy in 1 case, Left inferior lobectomy in 1 case, right superior lobectomy in 1 case and middle lobectomy and paracardiac segmentectomy. Sleeve resection of the pulmonary artery was performed in two patients. There were no deaths or major postoperative complications. Mean hospital stay after surgery was 12 days (rang: 8-19). Histological examination confirmed the diagnosis of IPA. CT is essential to determine the optimal timing for surgery.
Bernard
A
A
Clinique Chirurgicale Universitaire, CHU, Hôpital du Bocage, Dijon.
Loire
J
J
Caillot
D
D
Casasnovas
O
O
Couailler
J F
JF
Guy
H
H
Favre
J P
JP
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D003131:Combined Modality Therapy; D004635:Emergency Medicine; D005260:Female; D006469:Hemoptysis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008172:Lung Diseases, Fungal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D011013:Pneumonectomy / Q000379:methods; D011300:Preoperative Care
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B
Résections pulmonaires en urgence pour aspergillose invasive chez des patients neutropéniques.