Stage surgical tactics in the treatment of pulmonary aspergilloma

Abstract

Purpose: To describe the clinical case of pulmonary aspergilloma with step-by-step surgical treatment. Surgical treatment of aspergilloma is justified in the case of ineffective drug therapy and life-threatening complications. The high risk of developing surgical complications on the background of immunodeficiency of different origins may be an obstacle to radical intervention. The course of aspergillosis can significantly limit the ability to compensate for background diseases such as diabetes. The case of a stage approach in preoperative preparation of a patient with severe diabetes mellitus and aspergilloma is presented. In the first stage, a video-assisted thoracoscopy of aspergilloma was performed with histological examination; evacuation of detritus and mycelium by transthoracic drainage and topical diabetes treatment. In the second stage: standard lower lobectomy and postoperative drug therapy with antifungal drugs. Observations up to 2 years after treatment with favorable course are analyzed. Conclusions. Aspergilloma is one form of aspergillosis that requires surgical treatment. Lack of effective correction of comorbidities may be an obstacle to one-step intervention because of the high risk of surgical complications. The use of video thoracoscopy in the diagnosis and stage treatment of this pathology is appropriate due to the minimal trauma of the intervention, which can be used for preoperative preparation and to obtain good results of radical treatment in this category of patients.

Keywords

• pulmonary aspergillosis
• surgery treatment
• video-assisted thoracoscopy