Topical treatmentoflife threatening haemoptysis fromaspergillomas

Background -Theefficacy oftopical treatmentof12episodes ofseverelife threateninghaemoptysis from a pulmonary aspergilloma in11patients isreviewed. Methods-A retrospective review wasperformedon fivewhiteandsixAfricanAmericanpatients ofmean age49years. The underlying diseases werebronchiectasis, sarcoidosis, tuberculosis, orhistoplasmosis. The patients wereprospectivelyconsidered poor surgical risks becausetheyhad a forcedexpiratory volumeinonesecond(FEV1)of<50% predicted andanarterial oxygentension (Pao2)of<7*95 kPabreathing room air. Assurgical intervention wasnotpossible, localintracavitary instillation ofsodium orpotassium iodide wasperformed. Two patients werepreviously treated withamphotericin B.Inonepatient sodiumiodide alonewasusedandintheremaining eight potassium iodide alonewasinstilled. The transcricothyroid approach wasusedinsix patients andthepercutaneous approach in five. Results - Haemoptysis ceasedwithin72 hoursinallpatients after theinstillation ofsodiumorpotassium iodide. Therewas nomorbidity ormortality, andsideeffects included slight irritation oninstillation of theiodide solution andoccasional cough whichwaseasily controlled. Allpatients werealive atleast oneyearlater. Conclusion -Intracavitary treatment isa viable option inthepoorriskpatient with lifethreatening haemoptysis from an aspergilloma. (Thorax 1996;51:253-255)