Chest
Volume 82, Issue 4, October 1982, Pages 430-432
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Clinical Investigations
Sarcoidosis and Aspergilloma: The Role of Surgery

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Fibrocystic pulmonary disease is a common sequel of chronic pulmonary sarcoidosis, and the subsequent development of intracavitary aspergillomas is frequent, especially in black patients. Pulmonary hemorrhage from aspergilloma is second only to cardiorespiratory failure as the cause of death in sarcoidosis. Opinions regarding the role of resectional surgery are conflicting. We report observations on 38 patients with biopsy evidence of antecedent sarcoidosis and cultural or serologic identification of Aspergillus species as cause of the fungus balls. Pulmonary fibrosis was bilateral and extensive in most cases, making surgical treatment perilous. Ten patients had moderate impairment of pulmonary function. Seven had surgical resection with six satisfactory results and one death. Three patients in this category have not required surgery. Twenty-eight patients had severely compromised pulmonary function. Surgery was performed in seven because of intractable bleeding; four survived, but three later died of respiratory failure. Of the 21 in this category not treated by surgery, six survived, four died of hemorrhage and 11 of respiratory failure. Of the 37 patients with aspergilloma whose status is known, 19 are dead, 14 survived wth positive precipitins and four, all treated surgically, recovered. It is concluded that surgical treatment of aspergilloma in patients with sarcoidosis should be avoided if possible, but is inescapable in a third of cases.

Section snippets

CLINICAL MATERIAL

Although equal numbers of white and black patients with sarcoidosis come under our care,8 aspergillomas were identified in 34 black and four white patients, indicating the greater frequency of severe pulmonary damage from sarcoidosis in black patients.

The diagnosis of aspergilloma was made on the basis of roentgenographic demonstration in each case of characteristic oval homogeneous densities surrounded by a halo of air, best seen in tomograms made in the upright posture. Evidence that the

RESULTS

Eighteen patients are known to be living and 19 dead, with the status of one patient unknown (Table 2). One postoperative death, from postoperative pulmonary aspergillosis and empyema, occurred among patients with fairly adequate pulmonary function. Recovery defined as subsidence of hemoptysis and disappearance of precipitins from the serum was obtained in four patients, all of whom had had resection. Two surgically treated and three nonsurgical patients survived with occasional hemorrhages and

DISCUSSION

Most studies of aspergilloma3, 4, 5, 6, 7 indicate that surgery had been performed in about one third of patients, but views differ regarding the indications for surgery. Solit et al3 noted that five of their patients had died of hemorrhage and recommended surgical intervention on the second episode of major bleeding. Varkey and Rose7 encountered no instances of fatal bleeding among 15 patients with aspergilloma and emphasized that death in their patients was related to the underlying disease

REFERENCES (9)

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Manuscript received November 20; revision accepted April 7.

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