Percutaneous treatment with amphotericin B of mycotic lung lesions from invasive aspergillosis: results in 10 immunocompromised patients

The aim of this Study was to evaluate the efficacy of percutaneous treatmen t of pulmonary lesions from invasive aspergillosis in immunocompromised pat ients. From 1992 to 1998, ten patients (seven men and three women; mean age 56 years) affected by hematological neoplasms (8 acute myeloid leukemias, 2 non-Hodgkin's lymphomas) and post-chemotherapy prolonged neutropenia deve loped pulmonary lesions from invasive aspergillosis. A total of 13 lesions (diameter 2-7 cm, median 5 cm) were treated percutaneously due to insuffici ency of the high-dose i.v. therapy; under CT guidance, a median of 10 cm(3) per session of a 1 mg/cm(3) diluted solution of amphotericin B was injecte d through a fine needle (21-22 G); 45 sessions overall were performed (one to five per lesions, median four), according to the volume of the nodules, tolerance and complications. The results were retrospectively evaluated eit her radiologically or clinically, Complications were cough, mild hemoptysis , and small pneumothorax and/or pleural effusion. No major complications oc curred. One month after the beginning of treatment, 8 lesions completely re solved, 4 greatly Improved, and 1 was not significantly reduced. In all ten patients symptoms improved (eight of ten could restart chemotherapy as sch eduled). After antiblastic retreatment, 1 patient had mycotic recurrence. I n our experience transthoracic topical treatment with amphotericin B of sin gle or few lung lesions from invasive aspergillosis was effective, affordin g a rapid improvement of the lesions and symptoms, and allowing continuatio n of chemotherapy as scheduled, thereby reducing the risk of recurrences.