Clinical profile and postoperative outcome in patients with simple and complex aspergilloma of lung.

OBJECTIVE To compare the clinical presentation and results of pulmonary resection in simple and complex aspergilloma of the lung. STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY The Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, from January 2003 to December 2008. METHODOLOGY Fifty-one adult patients with unilateral aspergilloma lung were included in this study. Patients were divided into two groups: A (simple aspergilloma-SA, n=14) and B (complex aspergilloma-CA, n=37), based on the radiological and operative characteristics of the cavitatory lesion and the presence or absence of extensive adhesions with the chest wall. Suitability for resection was assessed with arterial gases, pulmonary function tests and echocardiogram. Results were compared using Fishers exact test. RESULTS Recurrent hemoptysis was the predominant symptom in both the groups. Exertional dyspnea (A=21.4%; B=56.8%; p=0.03), chest pain (A=21.4%; B=59.5%; p=0.027), cough (A=35.7%; B=70.3%; p < 0.05) and postoperative complications like residual pleural space A=14.2%; B=54%; p=0.013) and pleural collection (A=7.1%; B=37.8%; p=0.041) were predominant in group B. Lobectomy was the most common procedure performed in group B (A=28.6%; B=59.5%), while wedge excision was performed in the majority of patients in group A (A=42.9%; B=29.7%). Recurrence of aspergilloma was seen in 3 patients (8.1%) in group B only. Total number of early and late complications in SA and CA were 7, and 60, respectively. Early mortality was 8.1% and 0.0% in group B and group A, [corrected] respectively (p=0.552). The overall mortality was 5.4%. CONCLUSION Symptoms were more frequently associated with CA as compared to SA. Surgery for CA was associated with low mortality but significant morbidity, whereas SA had low postoperative morbidity and no mortality.