Salvage Right Pneumonectomy in a Patient With Bronchial–Pulmonary Artery Fistula After Bilateral Sequential Lung Transplantation (original) (raw)
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Bronchopericardial fistula and pneumopericardium complicating invasive pulmonary aspergillosis
Clinical & Laboratory Haematology, 2008
The case report of a 14-year-old patient who developed a pneumopericardium with cardiac tamponade following pulmonary infection with Aspergillus niger 5 weeks after induction therapy for acute lymphoblastic leukaemia (ALL) is presented here. He improved following surgical drainage and treatment with amphotericin B. His case illustrates the difficulty in diagnosis of this condition.
European Respiratory Journal, 1995
Bronchial stump aspergillosis (BSA), i.e. Aspergillus infection of bronchial granulation tissue surrounding endobronchial suture threads, is a very rare variant of localized suppurative bronchial Aspergillus infection. The majority of reported cases have occurred within one year after lung surgery. We present three more patients, in whom BSA occurred very late (4.5, 6 and 7 yrs) after pulmonary resection. Other unusual features were: complete absence of symptoms in one patient, and simultaneous occurrence of aspergilloma in another. Removal of the endobronchial suture probably constitutes the key therapy for BSA. In all three of our patients oral itraconazole resulted in clinical, histological and microbiological improvement. In conclusion, BSA should be considered in the differential diagnosis of haemoptysis occurring up to 7 yrs after lung surgery, although an asymptomatic presentation is possible. Furthermore, BSA can be associated with other clinical presentations of Aspergillus...
Indian Journal of Surgery, 2020
The term aspergillosis describes the disease caused by Aspergillus species. The most common pathogen in this genus is Aspergillus fumigatus. Anatomic pulmonary resection is the preferred treatment modality in most of cases especially the presence of the localized disease, but sometimes patients complicate by prolonged air leakage, pleural space problems, and infection of this residual space. We reported a patient who undergone left upper lobectomy because of aspergilloma in the left upper lobe. After the operation, the patient's condition became complicated because of expansion failure of the lung and space problems. After the period of conservative treatment, urgent re-operation was needed because of acute hemorrhage from the chest tube. Hemorrhage was controlled, but disseminated pleural aspergillosis and infection in the pulmonary arterial stump were seen in the thoracic cavity. Completion pneumonectomy and pleural decortication were applied, and the antifungal therapy was arranged. With this report, we aim to evaluate the relation between disseminated pleural aspergillosis and inflammatory erosion of pulmonary arterial stump. It is also important to consider possibility of dissemination of the Aspergillus infection especially in patients with expansion failure after lung resection.
Subacute invasive pulmonary aspergillosis (IPA) represents a form of chronic pulmonary aspergillosis which affects immunocompetent individuals or mildly immunocompromised persons with underlying pulmonary disease. Pneumothorax can be a rare complication of subacute IPA due to a leakage of air from an air-filled lung cavitation into the pleural space. Herein, we report rare and unusual case of pneumothorax in a patient with pulmonary cavity infection. A 40-year-old woman was admitted to thoracic surgery due to complete pneumothorax of the left lung. She was active smoker with untreated chronic obstructive pulmonary disease (COPD). After thoracic drainage multiple cavity forms in both lungs were noticed. Galactomannan antigen was positive in bronchoalveolar lavage as well as culture of Aspergillus fumigatus. Antifungal treatment by voriconazole was started and continued for 6 months with a favorable outcome. This case highlights that subacute IPA is a diagnose that should be considered in patients with end-stage COPD, low body mass index, or patient who developed pneumothorax. The results of our case show that voriconazole is a safe and effective treatment as primary or salvage therapy in subacute forms of IPA, irrespective of the immunological status of the patients.
ASPERGILLUS TRACHEOBRONCHITIS: REPORT OF 8 CASES AND REVIEW
European Journal of Internal Medicine, 2011
Aspergillus tracheobronchitis (AT) is an infrequent but severe form of invasive pulmonary aspergillosis in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We reviewed 8 cases of AT diagnosed in our tertiary care center during an 18-year period, as well as 148 cases previously reported in the English literature from 1985 to July 2011. The demographic, clinical, imaging, bronchoscopic, and outcome characteristics of every eligible patient were excerpted, and predictors of inhospital mortality were identified by logistic regression. Solid organ transplantation (SOT) (44.2%), hematologic malignancy (21.2%), neutropenia (18.7%), and chronic obstructive pulmonary disease (15.4%) were the most common underlying conditions reported. Most cases occurred in patients receiving long-term corticosteroid treatment (71.8%) or chemotherapy (25.0%). Fever and respiratory complaints (cough, dyspnea, stridor, or wheezing) were the most frequent symptoms; one-third of patients developed acute respiratory distress at presentation, and 15.1% were asymptomatic at the time of diagnosis. Initial imaging studies were not informative in 47.4% of the cases. Aspergillus fumigatus was the predominant species (74.4%). The pseudomembranous form was the most commonly observed (31.9% of cases) and was more frequent in neutropenic patients (p = 0.007), whereas ulcerative AT (31.2%) was associated with SOT (p = 0.001). The most frequent antifungal monotherapy regimens were amphotericin B deoxycholate (23.1%) and itraconazole (18.6%), whereas combined therapy was administered in 35.9% of the cases. Overall inhospital mortality was 39.1%, with neutropenia (odds ratio EOR^, 20.47; p G 0.001) and acute respiratory distress at presentation (OR, 9.54; p = 0.002) as independent prognostic factors. Our pooled analysis of the literature shows that AT remains a rare opportunistic infection with a nonspecific presentation and a variable course depending on the nature of the predisposing factor. (Medicine 2012;91: 261Y273) Abbreviations: allo-HSCT = allogeneic hematopoietic stem cell transplantation, AmB-D = amphotericin B deoxycholate, AT = Aspergillus tracheobronchitis, BAL = bronchoalveolar lavage, CI = confidence interval, COPD = chronic obstructive pulmonary disease, CT = computed tomography, dsDNA = double-stranded DNA, G-CSF = granulocyte colony-stimulating factor, HIV = human immunodeficiency virus, HSCT = hematopoietic stem cell transplantation, ICU = intensive care unit, IMV = invasive mechanical ventilation, IPA = invasive pulmonary aspergillosis, IV = intravenous, L-AmB = liposomal amphotericin B, n-AmB = nebulized amphotericin B, OR = odds ratio, SLE = systemic lupus erythematosus, SOT = solid organ transplantation. From the Unit of Infectious Diseases (MFR, RSJ, BdD, FLM, ML, JMA),
The diagnosis and surgical treatment of pulmonary fungal infections
African Journal of Microbiology Research, 2012
The clinical signs, diagnosis, and surgical management experiences of 51 cases of pulmonary fungal infections were retrospectively summarized. The clinical data were taken from 51 pulmonary fungal infection patients treated in the Thoracic Surgery Department of the Chinese PLA General Hospital from 1981 to 2008. This case series included 3 cases of Candida albicans, 22 cases of Aspergillus, and 26 cases of Cryptococcus infection. Forty-eight of the patients underwent a standard thoracotomy operation, whereas the remaining 3 patients underwent a thoracoscopy or a thoracoscopy-assisted minithoracotomy. Seventeen patients underwent pulmonary lobectomies, and 34 underwent wedge resections. All of the diagnoses were confirmed by postoperative pathology. There was no operative mortality, but there were 4 postoperative complications. In conclusion, primary pulmonary fungal infections lack characteristic clinical manifestations and imaging findings. A pathological examination can provide evidence for a definitive diagnosis. Surgical intervention is effective for the diagnosis and treatment of this disease. There is no significant difference between the long-term efficacy of wedge resection and standard lobar resection. Pre-and postoperative antifungal medications can effectively prevent fungal dissemination and recurrence.