CT-guided percutaneous treatment of inoperable pulmonary aspergillomas: a study of 40 cases

Objective: To treat symptomatic pulmonary aspergilloma in patients who were not considered to be operable. Material and methods: Forty patients were t reated by CT-guided percutaneous injection, of amphotericin paste, the aim being to fill the cavity completely and create an anaerobic environment for the aspergillus. The aspergillomas had developed after bacillary infection and pulmonary fibrosis. Surgery was contra-indicated in these patients bec ause of severe respiratory failure. The authors detail the method of prepar ation of the paste and the technique of percutaneous injection. Results: He moptysis ceased in all 40 patients, with a follow-up ranging from 6 to 28 m onths; six patients were also treated with bronchial embolization. In 26 pa tients, the aspergilloma disappeared and serum tests for aspergillus became negative. Complete disappearance of both the aspergilloma and the cavity w as obtained in three patients. Conclusion: This technique appears to be a v aluable contribution to non-surgical treatment of inoperable patients with pulmonary aspergilloma, but study should be continued in a larger series to define the exact indications and the interaction with other treatments whi ch have recently been introduced. (C) 1998 Elsevier Science Ireland Ltd. Al l rights reserved.