Whathappens topatients withpulmonary aspergilloma? Analysis of23cases

Theproblems associated withpulmonary aspergilloma wereassessed retrospectively in23patients presenting from1953to1982. Haemoptysis occurred inoverhalf thepatients and intwoitwas fatal. Invasive aspergillosis occurred infivepatients, a higher proportion thanin earlier reports, andtwoofthese died. Amphotericin B incombination witheither flucytosine or natamycin and, more recently, ketoconazole haveproved useful inthetreatment ofthis condi- tion. Species ofaspergillus fungi arefoundthroughout theworldindecaying vegetation andsoil, andits spores areubiquitous inrural andurbanenviron- ments. Thefirst report ofpulmonary aspergillosis in manappeared in1842' andseveral patterns ofthe disease havesince beenrecognised,2 ranging from colonisation ofdamaged lung tissue bythefungus to invasive ornecrotising pulmonary aspergillosis.3 The mostdistinctive lesion istheaspergilloma,4 which forms whenthefungus growsonthewall ofalung cavity andmycelium anddebris become detached to formaconcretion ofamorphous material containing tangled septate hyphae andaltered blood elements. Thenatural history ofpulmonary aspergilloma is poorly documented andthere isnogeneral agree- mentonthebest formofmanagement. Thisreport analyses thetreatment andoutcome ofall cases seen attheNorthern General Hospital, Edinburgh, dur- ingthepast30years. Patients Twenty-three patients withaspergilloma were studied intheperiod 1953-82. Thecriteria fora diagnosis ofaspergilloma consisted oftheclassical radiological sign ofanintracavitary masswithasur- rounding crescent ofairandeither apositive result intheaspergillus precipitin test, asputumculture positive foraspergillus, or(inmostcases) both. Thepatients ranged inagefrom40to81years,