TREATMENT OF HEMOPTYSIS IN PATIENTS WITH CAVITARY ASPERGILLOMA OF THELUNG - VALUE OF PERCUTANEOUS INSTILLATION OF AMPHOTERICIN-B

OBJECTIVE. Surgery has been the primary choice of treatment for cavita ry aspergillomas of the lung, but it is associated with relatively hig h morbidity and mortality. The effectiveness of percutaneous intracavi tary instillation of an antifungal agent in seven patients with hemopt ysis caused by cavitary aspergilloma was evaluated. SUBJECTS AND METHO DS. All patients had hemoptysis associated with a cavitary pulmonary a spergilloma. In four patients who had aspergillomas without lung inter posed between the cavity and the chest wall, 50 mg of amphotericin B i n 10 ml of 5% dextrose in water and then 8 mg of bromhexine (a mucolyt ic agent) mixed with 10 ml of normal saline were instilled into the ca vity through an 8-French catheter daily for 15 days. In three patients who had lung interposed between the cavity and the chest wall, the tr eatment was administered twice at 3-day intervals through a 20-gauge n eedle. The presence or absence of hemoptysis was recorded after each i nstillation of amphotericin B, and the size of aspergilloma was assess ed with follow-up radiographs. RESULTS. Hemoptysis ceased within 5 day s after instillation of amphotericin B in all patients. In the four pa tients treated through a catheter, the aspergillomas resolved complete ly in three patients and resolved partially in one. In the three patie nts treated through a fine needle, the aspergillomas resolved partiall y. Mild hemoptysis during the procedure, a small pneumothorax, and sub cutaneous emphysema occurred in one patient each. CONCLUSION. Our resu lts suggest that percutaneous intracavitary instillation of amphoteric in B is a safe and effective method of treating hemoptysis caused by a spergillomas.