TOPICAL TREATMENT OF LIFE-THREATENING HEMOPTYSIS FROM ASPERGILLOMAS

Background - The efficacy of topical treatment of 12 episodes of sever e life threatening haemoptysis from a pulmonary aspergilloma in 11 pat ients is reviewed. Methods - A retrospective review was performed on f ive white and six African-American patients of mean age 49 years. The underlying diseases were bronchiectasis, sarcoidosis, tuberculosis, or histoplasmosis. The patients were prospectively considered poor surgi cal risks because they had a forced expiratory volume in one second (F EV(1)) of <50% predicted and an arterial oxygen tension (PaO2) of <7.9 5 kPa breathing room air. As surgical intervention was not possible, l ocal intracavitary instillation of sodium or potassium iodide was perf ormed. Two patients were previously treated with amphotericin B. In on e patient sodium iodide alone was used and in the remaining eight pota ssium iodide alone was instilled. The transcricothyroid approach was u sed in six patients and the percutaneous approach in five. Results - H aemoptysis ceased within 72 hours in all patients after the instillati on of sodium or potassium iodide. There was no morbidity or mortality, and side effects included slight irritation on instillation of the io dide solution and occasional cough which was easily controlled. All pa tients were alive at least one year later. Conclusion - Intracavitary treatment is a viable option in the poor risk patient with life threat ening haemoptysis from an aspergilloma.