TREATMENT OF SYMPTOMATIC PULMONARY ASPERGILLOMAS WITH INTRACAVITARY INSTILLATION OF AMPHOTERICIN-B THROUGH AN INDWELLING CATHETER

Background-The treatment of symptomatic pulmonary aspergillomas can be difficult. One approach has been to deliver antifungal drugs directly into the lung cavity. The use of this method of treatment is describe d in which an indwelling percutaneous catheter is used which avoids re peated needlings of the cavity and may allow extended treatment on a d omiciliary basis. Methods-Amphotericin B was delivered through indwell ing percutaneous intracavitary catheters to treat five symptomatic epi sodes in four patients with pulmonary aspergillomas. Results-The treat ment was well tolerated by all patients and their symptoms resolved in four of the five episodes. Two patients died, one from an unrelated b ronchopneumonia and the other from advanced cachexia. Two patients rem ain symptom free after eight and 12 months. Conclusions-Intracavitary administration of amphotericin through an indwelling catheter should b e considered for any patient who has troublesome sputum production, ha emoptysis, or systemic symptoms attributable to an aspergilloma.