title: Bronchoscopic removal of a large intracavitary pulmonary aspergilloma.
abstract: Pulmonary aspergilloma is a chronic fungal infection that has a high mortality when hemoptysis occurs. Surgery is the treatment of choice, but patients often have severe physiologic impairment putting them at risk for significant surgical morbidity and mortality. We present the case of a 63-year-old woman with a large aspergilloma, unfit for surgery due to medical reasons. The aspergilloma was enlarging, with progression of the patient's symptoms of anorexia, cough, chest discomfort, and hemoptysis. Bronchoscopy revealed an airway leading into a cavity with a large fungal ball. Biopsy confirmed Aspergillus fumigatus. Using flexible and rigid bronchoscopy, the aspergilloma was mechanically removed. Eighteen months later the patient reported no hemoptysis, reduced pain and cough, significant weight gain, and improved appetite, with no recurrence of the aspergilloma on repeat imaging. To our knowledge, this is the first reported case of bronchoscopic removal of a large cavitary aspergilloma. This important new treatment modality provides a viable alternative therapy for this potentially life-threatening problem.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB. Electronic address: davestather@yahoo.ca.
authors.forename: David R
authors.initials: DR
authors.lastname: Stather
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB.
authors.forename: Alain
authors.initials: A
authors.lastname: Tremblay
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB.
authors.forename: Paul
authors.initials: P
authors.lastname: MacEachern
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB.
authors.forename: Alex
authors.initials: A
authors.lastname: Chee
authors.affiliation: Department of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada.
authors.forename: Elaine
authors.initials: E
authors.lastname: Dumoulin
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB.
authors.forename: Olga
authors.initials: O
authors.lastname: Tourin
authors.affiliation: Department of Surgery, University of Calgary, Calgary, AB.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Gelfand
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Mody
mesh_terms: D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000150:complications / Q000601:surgery*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications