Objectives: To review some clinical features and lesions in computed tomography imaging of patients with aspergilloma had conducted Plombage procedure. Subjects and methods: Prospective study on 92 haemoptysis patients with Aspergilloma performed by Plombage surgery, review some clinical features and lesions in computed tomography imaging at the Department of Thoracic Surgery, Pham Ngoc Thach Hospital from November 2011 to November 2017.
Journal of military pharmaco-medicine no8-2018 CLINICAL AND IMAGING FEATURES ON CT-SCANER OF ASPERGILLOMA ON THORACIC PLOMBAGE PROCEDURE Le Tien Dung1; Nguyen Cong Minh2; Pham Vinh Quang3 Nguyen Van Nam3; Le Viet Anh3 SUMMARY Objectives: To review some clinical features and lesions in computed tomography imaging of patients with aspergilloma had conducted Plombage procedure Subjects and methods: Prospective study on 92 haemoptysis patients with Aspergilloma performed by Plombage surgery, review some clinical features and lesions in computed tomography imaging at the Department of Thoracic Surgery, Pham Ngoc Thach Hospital from November 2011 to November 2017 Results: Tuberculosis and haemoptysis were the most (92.4% and 100%) 100% of Aspergilloma position was on the upper lobe Fungus ball in cavity was 79.3% and 100% of Aspergilloma type II Conclusions: Computed tomography has an important role in the identification of lesions, diagnosis and indications for surgery * Keywords: Aspergilloma; Plombage surgery; Computed tomography INTRODUCTION Aspergillus was first reported by Virchow in 1856 The most frequently noticed fungal infections are Aspergilloma due to haemoptysis, sometimes heavy haemoptysis, which can lead to death About 17% of Aspergilloma grows in tuberculosis cavity The most of procedure of treatment of Aspergilloma is surgery, the indication of surgery based on the characteritics of lesions of Aspergilloma Most authors believe that computed tomography (CT) is a basic test to determine the diagnosis and to decide how to perform surgery, especially in Plombage surgery for haemoptysis due to Aspergilloma In the world, there are many authors who have studied this problem, but in Vietnam, there are few publications, especially about features of Aspergilloma that have indicated Plombage surgery on CT Therefore, we conducted study with the purpose: A review of some clinical features and lesions in CT imaging of patients with Aspergilloma has indicated Plombage procedure SUBJECTS AND METHODS Subjects 92 haemoptysis patients caused by Aspergilloma, underwent Plombage approach at the Department of Thoracic Surgery, Pham Ngoc Thach Hospital from November 2011 to November 2017 Pham Ngoc Thach Hospital Pham Ngoc Thach University of Medicine 103 Military Hospital Corresponding author: Le Tien Dung (letiendung291@yahoo.com) Date received: 05/08/2018 Date accepted: 24/09/2018 177 Journal of military pharmaco-medicine no8-2018 Research methods - Aspergilloma position - Aspergilloma size - Aspergilloma imaging - Other lession: Fibrosis, pleural plaque - Classification of Aspergilloma by Fraser J.W (1965), Stewart M Scott (1996) [8]: - Research methods: Prospective, descriptive study * Clinical criteria: - Age, gender - Medical history: Tuberculosis, bulla, bronchocyst, lung abscess, lung cancer - Clinical symptoms: Haemoptysis, phlegm, chest pain, dyspnea * CT’s image evaluation: + Type I: Simple, thin-walled cavity ≤ mm and have no lession around tumor + Type II: Complex, thick-walled > mm and/or have lession around tumor Figue 1: Type I Figue 2: Type II * Data processing: Epi.info 2003 RESULTS AND DISCUSSION Clinical characteristics Table 1: Clinical characteristics of Aspergilloma patients Clinical characteristics Gender Clinical criteria Male 70 76.1 22 23.9 52.8 ± 10.8 (26 - 79) Tuberculosis 85 92.4 Lung abscess 2.2 Bronchocyst 1.1 Bulla 4.3 Lung cancer 0 Haemoptysis 92 100.0 Phlegm 60 65.2 Chest pain 46 50.0 11 12.0 Dyspnea 178 % Female Age History Patients Journal of military pharmaco-medicine no8-2018 In our study, the youngest patient was 26 years old, the oldest was 79 years old, the average age was 52.8 Comparing to the other studies such as Babatasi’s, the mean age was 42 [4], Duong Thong’s was 42 [3] There were 76.1% male, three times higher than female (23.9%) Due to the development of Aspergilloma on the old tuberculosis, the rate of tuberculosis in men was higher than in women Tuberculosis history accounted for the highest rate in all studies, and our rate was 92.4% Pulmonary tuberculosis is a very serious complication, the results were complex damage as well as impairment of respiratory function With the incidence of new tuberculosis cases of 100/100,000 people, in which tuberculosis cavity is 15% [5] The most common symptom of Aspergilloma is recurrent haemoptysis, sometimes heavy haemoptysis, which can lead to death In our study, blood cough symptoms accounted for 100% High rates of blood cough symptoms had been reported in many domestic and foreign studies of Aspergilloma (from 81.8% to 93.8%) [2, 3] Fungal disease also had other symptoms such as phlegm, chest pain and dyspnea, which were also common in lung fungal infections However, it is not specific because it is a common symptom of other chronic diseases They are less noticeable if they are not accompanied by coughing blood [1] Imaging characteristics on CT Table 2: Aspergilloma position on CT Imaging characteristics Patients % Both side 4.3 Right upper lobe 44 47.8 Position Left upper lobe 40 43.6 Left lower lobe - Left upper - lower lobe 4.3 The exact location of lung tumors in the upper lobe is due to the fact that most of lung tumors develop on the tuberculosis cavity, which is caused by tuberculosis lesions, which usually reside in the lung apex Aspergilloma developed on the basis of old tuberculosis that developed in > 90% of pulmonary tuberculosis and left the upper lobe in sequelae This result was consistent with other studies by Babatasi (71.4%) [4], Chang (77%), Duong Thong (81%) [3] * Aspergilloma imaging on CT: On CT, fungus ball accounted for 79.3%, solid masses rate was 13% and spongy rate was 40.2% The fungus ball and solid masses were the most valuable standards for diagnosis of Aspergilloma And CT was the most important factor in diagnosis of Aspergilloma [7] * Other lessions on CT: The other lessions on CT were pleural thickening (98.9%), fibrosis (82.6%), calcification (68.5%), emphysema (47.8%), nodules fibrosis (45.7%), nodules (22.8%), invasive (12%), bronchiectasis (10.9%) and masses (7.6%) The other accompanied lessions on CT such as pleural thickening, emphysema, calcification, bronchiectasis were prognosis for the results of operation [9] 179 Journal of military pharmaco-medicine no8-2018 * Aspergilloma size on CT: On CT, the Aspergilloma size of cm accounted for 1,1% (1 patient), size of cm was patients (7.6%), size of cm was 22 patients (23.9%), size of cm was 15 patients (16.3%), size of cm was 16 patients (17.4%), size of cm was 8.7% (8 patients) and size of ≥ 10 cm was 24.9% (23 patients) * Aspergilloma classification on CT: Aspergilloma type II (complex) was 100% There was no type I (simple) in Aspergilloma classification Indication and prognosis of surgery for Aspergilloma depend on size and classification of tumor on CT In our study, Aspergilloma type II was 100%, the mean size of tumor was 7.2 cm Regnard J [10] researched on 89 patients: 84.3% of patients with type I that underwent lobectomy and 15.7% of patients with type II underwent thoracoplasty CONCLUSION After researching 92 haemoptysis patients with Aspergilloma, who were performed Plombage approach at the Department of Thoracic Surgery, Pham Ngoc Thach Hospital from November 2011 to November 2017, we have some comments: - Most of patients have a history of pulmonary tuberculosis (82.4%) with haemoptysis (100%) - On CT: All of Aspergilloma are located on upper lobe (100%), the fungus ball is in most cases with 79.3%, the accompanied lessions are pleural thickening, calcification, emphysema, bronchiectasis; Aspergilloma type II is 100% 180 REFERENCES Ngô Quý Châu CS Nấm phổi Bệnh hô hấp, NXB Giáo dục, Hà Nội 2012, tr.121-172 Nguyễn Công Minh U nấm phổi Aspergillus Tập san Hội Hình thái học Việt Nam 2001, (2), tr.97-106 Dương Thơng, Vũ Quang Việt, Nguyễn Hồi Nam CS Chẩn đoán điều trị u nấm phổi Aspergillus Bệnh viện Nhân dân Gia Định Kỷ yếu Hội thảo Pháp - Việt lần bệnh Phổi Phẫu thuật Lồng ngực 2000, tr.128-135 Babatasi G, Massetti M, Chapelier A, Fadel E, Macchiarini P, Khayat A, Dartevelle P Surgical treatment of pulmonary Aspergilloma: Current outcome J Thorac Cardiovasc Surg 2000, 119, pp.906-912 British Thoracic and Tuberculosis Association Aspergilloma in residual tubercular cavities - the results of a survey Tubercle 1970, 51, pp.227-45 Chang Kwon Park Results of surgical treatment for pulmonary Aspergilloma Eur J of Cardiothorac Surg 2000, 21, pp.918-923 Daly R.C, Pairolero P.C, Piehler J.M et al Pulmonary Aspergilloma: Results of surgical treatment J Thorac Cardiovasc Surg 1986, 92, pp.981-988 Fraser R.S Pulmonary aspergillosis: Pathology and pathogenetic Features Patho Annu 1993, 28, pp.231-277 Roberts C.M, Citron K.M, Strickland B Intrathoracic Aspergilloma: Role of CT in diagnosis and treatment Radiology 1987, 165, pp.123-128 10 Regnard J, Icard P, Nicolosi M, Spagiarri L, Magdeleinat P, Jauffret B et al Aspergilloma: A serie of 89 surgical cases Ann Thorac Surg 2007, 69, pp.898-903 ...Journal of military pharmaco-medicine no8-2018 Research methods - Aspergilloma position - Aspergilloma size - Aspergilloma imaging - Other lession: Fibrosis, pleural plaque - Classification of Aspergilloma. .. the most valuable standards for diagnosis of Aspergilloma And CT was the most important factor in diagnosis of Aspergilloma [7] * Other lessions on CT: The other lessions on CT were pleural thickening... calcification, bronchiectasis were prognosis for the results of operation [9] 179 Journal of military pharmaco-medicine no8-2018 * Aspergilloma size on CT: On CT, the Aspergilloma size of cm accounted