Percutaneous intracavitary treatment of pulmonary aspergilloma-clinical efficacy and prognosis

We have performed percutaneous intracavitary treatment with anti-fungal reagents in 8 patients with pulmonary aspergilloma (6 males and 2 female) over the past decade. Ages ranged from 43 to 84 years old. All of the patients had underlying lung diseases, seven having old pulmonary tuberculosis and one pneumoconiosis. Five patients had a history of hemoptysis or hemosputum. Amphotericin B (AMPH) was injected daily in 5 patients, Fulconazol (FCZ) in 2 patients, and both in the remaining patient. For AMPH, maximal dose, total dose, and treatment duration were 20 to 50 mg, 285 to 1560 mg, and one to 7.5 months, respectively, and for FCZ, 20 to 30 mg, 450 to 1600 mg, 3 weeks to 4 months, respectively. At the end of treatment, fungus balls disappeared in 2 patients, decreased in size in 3 patients and were unchanged in 3 patients. After follow up periods of 7 months through 6.5 years, 5 of 6 patients remained in roentogenologically better condition than before treatment, and 3 of 5 patients with episodes of hemoptysis or hemosputum have not since had airway bleeding. The prognosis of the other two patients are unknown, since they died of other diseases before this survey. One patient had aspergillus empyema 7 months after treatment. There were no serious side effects or complications directly related to treatment. It was suggested that continuous percutaneous intracavitary treatment with anti-fungal reagents is safe and effective for inoperable patients with aspergilloma.