Surgical Treatment of Pulmonary Mycosis

We reviewed 10 cases of pulmonary aspergillosis and 3 cases of pulmonary cryptococcosis treated surgically from 1975 to 1988.Nine of the ten patients with pulmonary aspergillosis had clinical symptoms before surgery and nine had a previous history of disease (five, pulmonary tuberculosis : two, diabetes : one, pulmonary abscess). Lobectomy was performed in seven patients, segmentectomy in one patient and cavernostomy in two in whom resection was contraindicated because of poor pulmonary function. Four patients had more than 2000 g of blood loss during the operation. After surgery two of the patients with pulmonary aspergillosis died of severe infection and one died suddenly of a heart attack.We suspected lung cancer in two patients and benign lung tumor in one patient with primary pulmonary cryptococcosis because of their chest X-ray film findings. Pulmonary cryptococcosis was diagnosed as benign granulomas by intraoperative frozen specimens in all patients and only partial pulmonary resection was done. They were treated with 5-Flucytosine, 6 to 8g/day for two weeks after operation and are doing well postoperatively.Our observations suggest that surgical resection for pulmonary aspergillosis must be done carefully to minimize bleeding due to severe pleural adhesions and that patients with pulmonary cryptococcosis should be observed carefully after resection because of the possibility of postoperative meningitis.