Clinical and imaging features on ct-scaner of ASPergilloma on thoracic plombage procedure – Le Tien Dung

Journal of military pharmaco-medicine n o 8-2018 177 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 1. 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. 1. Pham Ngoc Thach Hospital 2. Pham Ngoc Thach University of Medicine 3. 103 Military Hospital Corresponding author: Le Tien Dung (letiendung291@yahoo.com) Date received: 05/08/2018 Date accepted: 24/09/2018 Journal of military pharmaco-medicine n o 8-2018 178 2. Research methods. - 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: - Aspergilloma position. - Aspergilloma size. - Aspergilloma imaging. - Other lession: Fibrosis, pleural plaque. - Classification of Aspergilloma by Fraser J.W (1965), Stewart M Scott (1996) [8]: + Type I: Simple, thin-walled cavity ≤ 3 mm and have no lession around tumor. + Type II: Complex, thick-walled > 3 mm and/or have lession around tumor. Figue 1: Type I. Figue 2: Type II. * Data processing: Epi.info 2003. RESULTS AND DISCUSSION 1. Clinical characteristics. Table 1: Clinical characteristics of Aspergilloma patients. Clinical characteristics Patients % Male 70 76.1 Gender Female 22 23.9 Age 52.8 ± 10.8 (26 - 79) Tuberculosis 85 92.4 Lung abscess 2 2.2 Bronchocyst 1 1.1 Bulla 4 4.3 History Lung cancer 0 0 Haemoptysis 92 100.0 Phlegm 60 65.2 Chest pain 46 50.0 Clinical criteria Dyspnea 11 12.0 Journal of military pharmaco-medicine n o 8-2018 179 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]. 2. Imaging characteristics on CT. Table 2: Aspergilloma position on CT. Imaging characteristics Patients % Both side 4 4.3 Right upper lobe 44 47.8 Left upper lobe 40 43.6 Left lower lobe 0 - Position Left upper - lower lobe 4 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]. Journal of military pharmaco-medicine n o 8-2018 180 * Aspergilloma size on CT: On CT, the Aspergilloma size of 4 cm accounted for 1,1% (1 patient), size of 5 cm was 7 patients (7.6%), size of 6 cm was 22 patients (23.9%), size of 7 cm was 15 patients (16.3%), size of 8 cm was 16 patients (17.4%), size of 9 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%. REFERENCES 1. Ngô Quý Châu và CS. Nấm phổi. Bệnh hô hấp, NXB Giáo dục, Hà Nội. 2012, tr.121-172. 2. 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