Objectives: To review some clinical features and lesions in computed tomography imaging of patients with aspergilloma had conducted Plombage procedure. Subjects and methods: Prospective study on 92 haemoptysis patients with Aspergilloma performed by Plombage surgery, review some clinical features and lesions in computed tomography imaging at the Department of Thoracic Surgery, Pham Ngoc Thach Hospital from November 2011 to November 2017.
Trang 1CLINICAL AND IMAGING FEATURES ON CT-SCANER OF ASPERGILLOMA ON THORACIC PLOMBAGE PROCEDURE
Le Tien Dung 1 ; Nguyen Cong Minh 2 ; Pham Vinh Quang 3 Nguyen Van Nam 3 ; Le Viet Anh 3
SUMMARY
Objectives: To review some clinical features and lesions in computed tomography imaging of patients with aspergilloma had conducted Plombage procedure Subjects and methods: Prospective study on 92 haemoptysis patients with Aspergilloma performed by Plombage surgery, review some clinical features and lesions in computed tomography imaging at the Department of Thoracic Surgery, Pham Ngoc Thach Hospital from November 2011 to November
2017 Results: Tuberculosis and haemoptysis were the most (92.4% and 100%) 100% of Aspergilloma position was on the upper lobe Fungus ball in cavity was 79.3% and 100% of Aspergilloma type II Conclusions: Computed tomography has an important role in the identification of lesions, diagnosis and indications for surgery
* Keywords: Aspergilloma; Plombage surgery; Computed tomography
INTRODUCTION
Aspergillus was first reported by
Virchow in 1856 The most frequently
noticed fungal infections are Aspergilloma
due to haemoptysis, sometimes heavy
haemoptysis, which can lead to death
About 17% of Aspergilloma grows in
tuberculosis cavity The most of procedure
of treatment of Aspergilloma is surgery,
the indication of surgery based on the
characteritics of lesions of Aspergilloma
Most authors believe that computed
tomography (CT) is a basic test to
determine the diagnosis and to decide
how to perform surgery, especially in
Plombage surgery for haemoptysis due to
Aspergilloma
In the world, there are many authors who have studied this problem, but in Vietnam, there are few publications, especially about features of Aspergilloma that have indicated Plombage surgery on CT Therefore, we conducted study with
the purpose: A review of some clinical
features and lesions in CT imaging of patients with Aspergilloma has indicated Plombage procedure
SUBJECTS AND METHODS
1 Subjects
92 haemoptysis patients caused by
Aspergilloma, underwent Plombage approach
at the Department of Thoracic Surgery, Pham Ngoc Thach Hospital from November
2011 to November 2017
1 Pham Ngoc Thach Hospital
2 Pham Ngoc Thach University of Medicine
3 103 Military Hospital
Corresponding author: Le Tien Dung (letiendung291@yahoo.com)
Date received: 05/08/2018
Date accepted: 24/09/2018
Trang 22 Research methods
- Research methods: Prospective,
descriptive study
* Clinical criteria:
- Age, gender
- Medical history: Tuberculosis, bulla,
bronchocyst, lung abscess, lung cancer
- Clinical symptoms: Haemoptysis, phlegm,
chest pain, dyspnea
* CT’s image evaluation:
- Aspergilloma position
- Aspergilloma size
- Aspergilloma imaging
- Other lession: Fibrosis, pleural plaque
- Classification of Aspergilloma by Fraser J.W (1965), Stewart M Scott (1996) [8]: + Type I: Simple, thin-walled cavity ≤ 3 mm and have no lession around tumor
+ Type II: Complex, thick-walled > 3 mm
and/or have lession around tumor
* Data processing: Epi.info 2003
RESULTS AND DISCUSSION
1 Clinical characteristics
Table 1: Clinical characteristics of Aspergilloma patients.
Gender
History
Clinical criteria
Trang 3In our study, the youngest patient was
26 years old, the oldest was 79 years old,
the average age was 52.8 Comparing to
the other studies such as Babatasi’s, the
mean age was 42 [4], Duong Thong’s was
42 [3]
There were 76.1% male, three times
higher than female (23.9%) Due to the
development of Aspergilloma on the old
tuberculosis, the rate of tuberculosis in
men was higher than in women
Tuberculosis history accounted for the
highest rate in all studies, and our rate
was 92.4% Pulmonary tuberculosis is a
very serious complication, the results
were complex damage as well as
impairment of respiratory function With
the incidence of new tuberculosis cases
of 100/100,000 people, in which
tuberculosis cavity is 15% [5]
The most common symptom of
Aspergilloma is recurrent haemoptysis,
sometimes heavy haemoptysis, which can
lead to death In our study, blood cough
symptoms accounted for 100% High rates
of blood cough symptoms had been
reported in many domestic and foreign
studies of Aspergilloma (from 81.8% to
93.8%) [2, 3] Fungal disease also had
other symptoms such as phlegm, chest
pain and dyspnea, which were also common
in lung fungal infections However, it is not
specific because it is a common symptom
of other chronic diseases They are less
noticeable if they are not accompanied by
coughing blood [1]
2 Imaging characteristics on CT
Table 2: Aspergilloma position on CT
Position
The exact location of lung tumors in the upper lobe is due to the fact that most
of lung tumors develop on the tuberculosis cavity, which is caused by tuberculosis lesions, which usually reside in the lung apex Aspergilloma developed on the basis of old tuberculosis that developed
in > 90% of pulmonary tuberculosis and left the upper lobe in sequelae This result was consistent with other studies by Babatasi (71.4%) [4], Chang (77%), Duong Thong (81%) [3]
* Aspergilloma imaging on CT:
On CT, fungus ball accounted for 79.3%, solid masses rate was 13% and spongy rate was 40.2% The fungus ball and solid masses were the most valuable standards for diagnosis of Aspergilloma And CT was the most important factor in diagnosis of Aspergilloma [7]
* Other lessions on CT:
The other lessions on CT were pleural thickening (98.9%), fibrosis (82.6%), calcification (68.5%), emphysema (47.8%), nodules fibrosis (45.7%), nodules (22.8%), invasive (12%), bronchiectasis (10.9%) and masses (7.6%) The other accompanied lessions on CT such as pleural thickening, emphysema, calcification, bronchiectasis were prognosis for the results of operation [9]
Trang 4* Aspergilloma size on CT:
On CT, the Aspergilloma size of 4 cm
accounted for 1,1% (1 patient), size of
5 cm was 7 patients (7.6%), size of 6 cm
was 22 patients (23.9%), size of 7 cm was
15 patients (16.3%), size of 8 cm was
16 patients (17.4%), size of 9 cm was
8.7% (8 patients) and size of ≥ 10 cm was
24.9% (23 patients)
* Aspergilloma classification on CT:
Aspergilloma type II (complex) was
100% There was no type I (simple) in
Aspergilloma classification
Indication and prognosis of surgery for
Aspergilloma depend on size and
classification of tumor on CT In our study,
Aspergilloma type II was 100%, the mean
size of tumor was 7.2 cm Regnard J [10]
researched on 89 patients: 84.3% of
patients with type I that underwent
lobectomy and 15.7% of patients with
type II underwent thoracoplasty
CONCLUSION
After researching 92 haemoptysis patients
with Aspergilloma, who were performed
Plombage approach at the Department
of Thoracic Surgery, Pham Ngoc Thach
Hospital from November 2011 to November
2017, we have some comments:
- Most of patients have a history of
pulmonary tuberculosis (82.4%) with
haemoptysis (100%)
- On CT: All of Aspergilloma are located
on upper lobe (100%), the fungus ball is in
most cases with 79.3%, the accompanied
lessions are pleural thickening, calcification,
emphysema, bronchiectasis; Aspergilloma
type II is 100%
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