Aspergilloma

An aspergilloma (mycetoma) is a mass of fungal elements, inflammatory cells, and mucus/tissue debris which forms in a pre-existing lung cavity. It is a noninvasive type of chronic pulmonary aspergillosis. The infection can also appear in the brain, kidney, or other organs.

Causes

Aspergillosis is an infection caused by the fungus aspergillus. Aspergillomas are formed when the fungus grows in a clump in a lung cavity. The cavity is often created by a previous condition. Cavities in the lung may be caused by diseases such as:

• Tuberculosis
• Coccidioidomycosis
• Cystic fibrosis
• Histoplasmosis
• Lung abscess
• Lung cancer
• Sarcoidosis

The most common species of fungus that causes disease in humans is Aspergillus fumigatus.

Symptoms

Aspergillomas may produce no symptoms or cause only a mild cough at first. Over time and without treatment, however, aspergillomas can worsen the underlying chronic lung condition and possibly cause:

• A cough that often brings up blood (hemoptysis)
• Wheezing
• Shortness of breath
• Unintentional weight loss
• Fatigue

Diagnosis

• Imaging test. A chest X-ray or computerized tomography (CT) scan — a type of X-ray that produces more-detailed images than conventional X-rays do — can usually reveal a fungal mass (aspergilloma), as well as characteristic signs of invasive aspergillosis and allergic bronchopulmonaryaspergillosis.
• Respiratory secretion (sputum) test. In this test, a sample of your sputum is stained with a dye and checked for the presence of aspergillus filaments. The specimen is then placed in a culture that encourages the mold to grow to help confirm the diagnosis.
• Tissue and blood tests. Skin testing, as well as sputum and blood tests, may be helpful in confirming allergic bronchopulmonary aspergillosis. For the skin test, a small amount of aspergillus antigen is injected into the skin of your forearm. If your blood has antibodies to the mold, you'll develop a hard, red bump at the injection site. Blood tests look for high levels of certain antibodies, indicating an allergic response.
• Biopsy. In some cases, examining a sample of tissue from your lungs or sinuses under a microscope may be necessary to confirm a diagnosis of invasive aspergillosis.

Treatment

Aspergillosis treatments vary with the type of disease. Possible treatments include:

• Observation. Simple, single aspergillomas often don't need treatment, and medications aren't usually effective in treating these fungal masses. Instead, aspergillomas that don't cause symptoms may simply be closely monitored by chest X-ray. If the condition progresses, then antifungal medications may be recommended.
• Oral corticosteroids. The goal in treating allergic bronchopulmonaryaspergillosis is to prevent existing asthma or cystic fibrosis from worsening. The best way to do this is with oral corticosteroids. Antifungal medications by themselves aren't helpful for allergic bronchopulmonaryaspergillosis, but they may be combined with corticosteroids to reduce the dose of steroids and improve lung function.
• Antifungal medications. These drugs are the standard treatment for invasive pulmonary aspergillosis. The most effective treatment is a newer antifungal drug, voriconazole (Vfend). Amphotericin B is another option.
  All antifungal drugs can have serious side effects, including kidney and liver damage. Interactions between antifungal drugs and other medications are also common.
• Surgery. Because antifungal medications don't penetrate an aspergilloma very well, surgery to remove the fungal mass is the first-choice treatment when an aspergilloma causes bleeding in the lungs. In or unit most of these surgeries are done by VATS or Robotic Methods.
• Embolization. This procedure stops lung bleeding caused by an aspergilloma. A radiologist injects a material through a catheter that has been guided into an artery feeding a lung cavity where an aspergilloma is causing blood loss. The injected material hardens, blocking the blood supply to the area and stopping the bleeding. This treatment works temporarily, but the bleeding is likely to start again.

FAQs

1. What is the current treatment for aspergilloma?

The size of the fungal mass, the patient's overall health, and the symptoms are what determine the current course of treatment for aspergilloma, a fungal infection caused by the Aspergillus species. Watchful waiting is generally advised for patients with minimal or no symptoms, along with routine imaging and clinical evaluation monitoring. Treatment options for aspergilloma may include antifungal drugs (such as voriconazole or itraconazole) to help lower the fungal burden and treat respiratory problems or coughing up blood (hemoptysis). However, these drugs may not always completely eradicate the fungus. Surgery to remove the fungal ball (aspergilloma) may be required in extreme situations. Other alternatives include embolization, which is a minimally invasive surgery that blocks the blood arteries that supply the aspergilloma in order to reduce bleeding.

2. What is the first-line treatment for aspergilloma?

Whether a patient has symptoms or not usually determines the best course of action for aspergilloma. The first line of treatment is generally conservative involving frequent monitoring for individuals who show minimal or no symptoms. Antifungal drugs like voriconazole or itraconazole may be used as the first line of treatment to help lower the fungal activity in patients exhibiting symptoms like severe hemoptysis. These drugs, however, do not always work to get rid of the fungal mass entirely. In more severe cases, surgery is often considered the first-line treatment, especially for patients at risk of life-threatening complications.

3. Is aspergilloma serious?

Yes. Aspergilloma can be dangerous, especially if it causes major or potentially fatal consequences like hemoptysis (coughing up blood). Aspergilloma can increase respiratory symptoms and worsen the course of chronic obstructive pulmonary disease (COPD) and tuberculosis in people with underlying lung diseases. The fungal mass can expand or cause repeated bleeding, but it can also stay stable for years in certain situations. In very rare cases, it can worsen and develop into chronic pulmonary aspergillosis, which calls for more intensive care. As a result, even though some aspergillomas are benign and asymptomatic, if complications develop or the condition is not addressed, it may become serious.

4. How do you remove aspergilloma?

A lobectomy or segmentectomy, which is the surgical removal of aspergilloma, involves the excision of the lung tissue that contains the fungal tumour. Patients with severe or repeated symptoms, especially those with frequent or potentially fatal hemoptysis, are typically advised to have this procedure. Considering the chances of bleeding, the process can be complicated, but because it eliminates the fungus ball entirely, it provides the most conclusive cure. By obstructing the blood vessels that supply the aspergilloma, bronchial artery embolization can be used to limit bleeding when surgery is not an option because of poor lung function or other health difficulties. While the fungal mass remains, this can help control the symptoms and lower the possibility of developing other problems.