Monaldi cavernostomy for lung aspergillosis: A case report

Petreanu,Cornel; Croitoru,Alina; Gibu,Alexandru; Zariosu,Alexandru; Bacalbasa,Nicolae; Balescu,Irina; Diaconu,Camelia; Stiru,Ovidiu; Dimitriu,Mihai; Cretoiu,Dragos; Savu,Cornel

doi:10.3892/etm.2021.10389

Monaldi cavernostomy for lung aspergillosis: A case report

Authors:
- Cornel Petreanu
- Alina Croitoru
- Alexandru Gibu
- Alexandru Zariosu
- Nicolae Bacalbasa
- Irina Balescu
- Camelia Diaconu
- Ovidiu Stiru
- Mihai Dimitriu
- Dragos Cretoiu
- Cornel Savu
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Affiliations: Department of Thoracic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Thoracic Surgery, ‘Marius Nasta’ National Institute of Pneumology, 050159 Bucharest, Romania, Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Visceral Surgery, ‘Ponderas’ Academic Hospital, 021188 Bucharest, Romania, Department of Internal Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Cardiovascular Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Cell and Molecular Biology and Histology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
Published online on: July 6, 2021 https://doi.org/10.3892/etm.2021.10389
Article Number: 957
Copyright: © Petreanu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Pulmonary aspergillosis in patients with respiratory failure can severely affect the pulmonary functional status and may aggravate it through pulmonary suppuration, by recruitment of new parenchyma and hemoptysis, which can sometimes be massive, with lethal risk by flooding the bronchus. The treatment consists of a combination of medical therapy, surgery and interventional radiology. In small lesions, less than 2‑3 cm, medical therapy methods may be sufficient; however, in invasive forms (larger than 3 cm) surgical resection is necessary. Surgical resection is the ideal treatment; nevertheless, when lung function does not allow it, action must be taken to eliminate the favorable conditions of the infection. In such cases, whenever the lung cavity is peripheral, a cavernostomy may be performed. Four cases of lung cavernous lesions colonized with aspergillus, in which the need for a therapeutic gesture was imposed by repeated small to medium hemoptysis and by the progression of respiratory failure, were evaluated, one of which is presented in the current study. Cavernostomy closure can be realized either surgically with muscle flap or spontaneously by scarring, after closure of the bronchial fistulas by epithelization and granulation. There were no recurrences of hemoptysis or suppurative phenomena. There was one death, a patient with severe respiratory failure caused by superinfection with nonspecific germs. However, in the case presented in this study, the patient recovered following cavernostomy, which seems to be an effective and safe method for cases in which lung resection is not feasible.

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