Current Surgical Strategies for Chronic Cavitary Pulmonary Aspergillosis

2009 
Treatment of pulmonary aspergillosis has to be individualized. Surgery is usually the treatment of choice for immunocompetent patients with a single fungal ball and adequate lung function. Surgery in patients with complex fungal ball could also be done for patients who persist with symptoms despite medical therapy or in cases where a lung tumour or other diagnoses are being considered. Pulmonary resection may also be indicated in patients with massive haemoptysis. To diminish operative complications in patients with complex fungal ball, cavernostomy and obliteration of the cavity by a thoracoplasty using intrathoracic transposition of extrathoracic skeletal muscle should be performed. These techniques may be proposed for patients in whom respiratory failure does not allow for a pulmonary resection to be performed. These operations are rather exceptional, but the results in those categories of high-operative risk patients are reasonable. Additional studies are mandatory to substantiate these results.
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