Aspergilloma of the Lungs: Operative experience from Tikur Anbessa Hospital, Ethiopia

Background: Pulmonary aspergilloma represents a potentially life-threatening disease caused by saprophytic growth of Aspergillus fumigates in pulmonary cavities. This is the first report of its operative treatment from Ethiopia.The aim of this study was to determine the clinical presentations, operative treatments and post operative outcome of patients with pulmonary aspergilloma. Methods: This was a retrospective review of patients’ record with post operative diagnosis of pulmonary aspergilloma treated over a period of three years between April 2005-March 2008 at The Tikur Anbessa hospital which is a teaching and referral hospital in Addis Ababa.
Results: Eleven patients were included, 81.8% of whom were males. Cough and hemoptysis were the two most common presenting symptoms, occurring in 11(100%) and 10(90.9%). The chest x-ray features typical for aspergilloma was seen in only 4(36.4%). The left lung was involved in 8(72.75%) and the upper lobes were the most commonly affected lobes occurring in 10 (90.9%). The most frequent clinical indication for surgery was severe hemoptysis in 8 (72.75%). Left upper lobectomy was the most frequently performed surgery in 4(36.4%) and left pneumonectomy in 3(27.3%). Four significant complications occurred in the postoperative period and one patient died, making the postoperative mortality 9.1%. Histopathologic confirmation of the fungal ball was possible in 10 patients and the most common underlying cavitary disease was tuberculosis in 9(90%). Conclusion: Aspergilloma is not an uncommon disease in Ethiopia and the diagnosis should be considered in patients who present with hemoptysis or chronic non-resolving cough. Surgery for pulmonary aspergilloma accounted for 5.8% of all thoracotomies done at the hospital and we have adopted the policy of early surgical treatment for all cases. In our series, the commonest lung pathology behind the aspergillus lesions was cavitary pulmonary tuberculosis, similar to many reports. Since the typical x/ray finding is not present in all patients, we believe that a supportive x/ray finding is sufficient enough an investigation to decide on early surgery in patients who present with suggestive symptoms.