Non-surgical treatment options for pulmonary aspergilloma
| Autor: | Amanjit Gill, Angela L. Lang, Nikunj Rashmikant Chauhan, Min Lang |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Azoles
Male Pulmonary and Respiratory Medicine Hemoptysis medicine.medical_specialty Antifungal Agents medicine.medical_treatment Bronchial Arteries Conservative Treatment Aspergillosis Chest pain 03 medical and health sciences 0302 clinical medicine Amphotericin B medicine.artery medicine Humans 030212 general & internal medicine Embolization skin and connective tissue diseases business.industry Non surgical treatment medicine.disease Embolization Therapeutic respiratory tract diseases Surgery Radiation therapy Instillation Drug 030228 respiratory system Female Pulmonary Aspergillosis medicine.symptom Bronchial artery business Aspergilloma medicine.drug |
| Zdroj: | Respiratory Medicine. 164:105903 |
| ISSN: | 0954-6111 |
| DOI: | 10.1016/j.rmed.2020.105903 |
| Popis: | Aspergilloma, also known as mycetoma or fungus ball, is the most common manifestation of pulmonary involvement by Aspergillus species. The fungal ball typically forms within preexisting cavities of the lungs. Diagnosis requires both radiographic evidence along with serologic or microbiologic evidence of Aspergillus species involvement. While clinical features such as hemoptysis, chest pain, shortness of breath, cough, and fever are helpful in diagnosis, they are non-specific symptoms. Surgery is currently the mainstay of treatment for aspergilloma but is associated with considerable mortality and morbidity. Alternative options exist for patients who are poor surgical candidates and for those who prefer a less invasive treatment modality. Systemic treatment with amphotericin B is ineffective and is not recommended as a monotherapy, but systemic azoles is effective in approximately 50-80% of patients. Potential alternatives to surgery include intracavitary instillation or endobronchial administration of antifungal medication, as well as direct transbronchial aspergilloma removal. Bronchial artery embolization and radiotherapy are options to manage hemoptysis until definite eradication of the aspergilloma. More rigorous studies are needed to better establish non-surgical treatment paradigm for inoperable patients. |
| Databáze: | OpenAIRE |
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