Chest
Clinical InvestigationsSarcoidosis and Aspergilloma: The Role of Surgery
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
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Cited by (55)
Exacerbation of chronic pulmonary aspergillosis was associated with a high rebleeding rate after bronchial artery embolization
2019, Respiratory InvestigationCitation Excerpt :While antifungal therapy is the main treatment for control of pulmonary aspergillosis, surgical resection of the affected area may be needed to manage severe or persistent bleeding [8,9]. However, patients with CPA are more likely to have underlying lung diseases with decreased lung function or respiratory insufficiency and, as a result, surgery is often avoided [10,11]. Bronchial artery embolization (BAE) may be considered as a treatment for hemoptysis in such patients.
Airway mycosis in allergic airway disease
2019, Advances in ImmunologyCitation Excerpt :Initially considered to be an innocuous bystander in cavitary lesions in pulmonary sarcoidosis, aspergillus co-infection was eventually realized to be an important contributory factor in sarcoid-related morbidity (Lofgren & Lindgren, 1959). Approximately 3–12% of sarcoidosis patients demonstrate aspergillus precipitins and over 90% of these subjects will demonstrate radiographic aspergillomas (Denning, Pleuvry, & Cole, 2013; Uzunhan et al., 2017; Wollschlager & Khan, 1984) that may become symptomatic due to hemoptysis and lung parenchymal invasion with systemic spread of disease (Israel, Lenchner, & Atkinson, 1982). Overall, these studies demonstrate that airway mycosis strongly and adversely influences the course of sarcoidosis and may be a precursor condition to it.
Pulmonary Sarcoidosis
2008, Clinics in Chest MedicineCitation Excerpt :With pulmonary fibrosis as in stage IV, loss of volume, hilar retraction, and coarse linear bands may be observed on chest radiographs. With advanced fibrocystic sarcoidosis, large bullae (Fig. 7), cystic radiolucencies, distortion [23,24], mycetomas [25,26], or bronchiectasis may be observed [27,28]. Clinical features of stage IV vary broadly, but most patients complain of dyspnea, cough, and expectoration.
Aspergillosis and sarcoidosis
2007, Revue des Maladies RespiratoiresComorbidities of sarcoidosis
2022, Annals of Medicine
Manuscript received November 20; revision accepted April 7.