Noninvasive Aspergillus Pulmonary Disease

Marc A. Judson

doi:10.1055/s-2004-824904

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2004; 25(2): 203-219
DOI: 10.1055/s-2004-824904

Noninvasive Aspergillus Pulmonary Disease

Marc A. Judson¹

¹Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina

Abstract

Noninvasive Aspergillus pulmonary disease may be the result of a host response to Aspergillus antigens or colonization of the lung with Aspergillus species. The prototype example of each of these phenomena are allergic bronchopulmonary aspergillosis and aspergilloma. Allergic bronchopulmonary aspergillosis is a form of asthma associated with a Type I, III, and IV allergic response to Aspergillus antigens. It presents clinically as asthma but is also associated with bronchiectasis, airway destruction, and permanent lung injury if inadequately treated. Treatment consists of anti-inflammatory agents such as corticosteroids. Antifungal agents may also be useful to lower the fungal antigen load. Aspergillomas grow in areas of devitalized lung. They may manifest as asymptomatic radiographic abnormalities. The concern is that they may lead to hemoptysis that can be life threatening. Definitive treatment is surgical resection, but this is often prohibited because these patients often have inadequate lung function to tolerate thoracic surgery. Other treatment options include azoles and percutaneous instillation of antifungals.

KEYWORDS

Aspergillus - aspergilloma - allergic bronchopulmonary aspergillosis - therapy - azoles - corticosteroids

Full Text

References

REFERENCES

1 Stevens D A, Kan V L, Judson M A et al.. Practice guidelines for disease caused by Aspergillus . Clin Infect Dis. 2000; 30 696-709
2 Gerson S L, Talbot G H, Hurwitz S et al.. Prolonged granulocytopenia: the major risk factor fsor invasive pulmonary aspergillosis in patients with acute leukemia. Ann Intern Med. 1984; 100 345-351
3 Wald A, Leisenring W, van Burik J A et al.. Epidemiology of Aspergillus infections in a large cohort of patients undergoing bone marrow transplantation. J Infect Dis. 1997; 175 1459-1466
4 Hibberd P L, Rubin R H. Clinical aspects of fungal infection in organ transplant recipients. Clin Infect Dis. 1994; 19(suppl 1) S33-S40
5 Denning D W, Follansbee S E, Scolaro M et al.. Pulmonary aspergillosis in the acquired immunodeficiency syndrome. N Engl J Med. 1991; 324 654-662
6 Stevens D A, Schwartz H J, Lee J Y et al.. A randomized trial of itraconazole in allergic bronchopulmonary aspergillosis. N Engl J Med. 2000; 342 756-762
7 Shah A, Khan Z U, Charturvedi S et al.. Allergic bronchopulmonary aspergillosis with coexistent aspergilloma: a long-term follow-up. J Asthma. 1989; 26 109-115
8 Judson M A. Allergic bronchopulmonary aspergillosis. Pulmonary Critical Care Update. 2003; 17 lesson 17
9 Vlahakis N E, Aksamit T R. Diagnosis and treatment of allergic bronchopulmonary aspergillosis. Mayo Clin Proc. 2001; 76 930-938
10 Schuyler M R. Allergic bronchopulmonary aspergillosis. Clin Chest Med. 1983; 4 15-22
11 Patterson R, Greenberger P A, Harris K E. Allergic bronchopulmonary aspergillosis [editorial]. Chest. 2000; 118 7-8
12 Hinson K F, Moon A J, Plummer N S. Bronchopulmonary aspergillosis. Thorax. 1952; 7 317-333
13 Greenberger P. Allergic bronchopulmonary aspergillosis. Clin Allergy Immunol. 2002; 16 449-468
14 Ricketti A J, Greenberger P A, Patterson R. Immediate-type reactions in patients with allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 1983; 71 541-545
15 Malo J L, Hawkins R, Pepys J. Studies in chronic allergic bronchopulmonary aspergillosis: clinical and physiological findings. Thorax. 1977; 32 254-261
16 Varkey B. Allergic bronchopulmonary aspergillosis: clinical perspectives. Immunol Allergy Clin North Am. 1998; 18 480-501
17 Graves T S, Fink J N, Patterson R, Kurup V P, Scanlon G T. A familial occurrence of allergic bronchopulmonary aspergillosis. Ann Intern Med. 1979; 91 378-382
18 Halwig M J, Kurup V P, Greenberger P A, Patterson R. A familial occurrence of allergic bronchopulmonary aspergillosis: a probable environmental source. J Allergy Clin Immunol. 1985; 76 55-59
19 Eaton T, Garrett J, Milne D, Frankel A, Wells A U. Allergic bronchopulmonary aspergillosis in an asthma clinic. Chest. 2000; 118 66-72
20 Patterson R, Greenberger P A, Halwig J M, Liotta J L, Roberts M. Allergic bronchopulmonary aspergillosis: natural history and classification of early disease by serologic and roentegographic studies. Arch Intern Med. 1986; 146 916-918
21 Basich J E, Graves T S, Nasir Baz M et al.. Allergic bronchopulmonary aspergillosis in corticosteroid-dependent asthmatics. J Allergy Clin Immunol. 1981; 68 98-102
22 Mrouch S, Spock A. Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis. Chest. 1994; 105 32-36
23 Neppmuceno I B, Esrig S, Moss R B. Allergic bronchopulmonary aspergillosis in cystic fibrosis. Chest. 1999; 115 364-370
24 McCarthy D S, Simon G, Hargreave F E. The radiological appearances in allergic bronchopulmonary aspergillosis. Clin Radiol. 1970; 21 366-375
25 Neeld D A, Goodman L R, Gurney J W et al.. Computerized tomography in the evaluation of allergic bronchopulmonary aspergillosis. Am Rev Respir Dis. 1990; 142 1200-1205
26 Lynch D A. Imagine of asthma and allergic bronchopulmonary mycosis. Radiol Clin North Am. 1998; 36 129-142
27 Malo J P, Pepys J, Simon G. Studies in chronic allergic bronchopulmonary aspergillosis, II: Radiological findings. Thorax. 1977; 32 262-268
28 Phelan M S, Kerr I H. Allergic bronchopulmonary aspergillosis: the radiological appearance during long-term follow-up. Clin Radiol. 1984; 35 385-392
29 Ward S, Heyneman L, Lee M J et al.. Accuracy of CT in the diagnosis of allergic bronchopulmonary aspergillosis in asthmatic patients. AJR Am J Roentgenol. 1999; 173 937-942
30 Mitchell T AM, Hamilos D L, Lynch D A, Newell J D. Distribution and severity of bronchiectasis in allergic bronchopulmonary aspergillosis. J Asthma. 2000; 37 65-72
31 Crameri R, Hemmann S, Ismail C, Menz G, Blaser K. Disease-specific recombinant allergens for the diagnosis of allergic bronchopulmonary aspergillosis. Int'l Immunol. 1998; 10 1211-1216
32 Banerjee B, Kurup V P, Greenberger P A, Johnson B D, Fink J N. Cloning and expression of Aspergillus fumigatus allergen Asp f 16 mediating both humoral and cell-mediated immunity in allergic bronchopulmonary asgergillosis (ABPA). Clin Exp Allergy. 2001; 31 761-770
33 Madan T, Banerjee B, Bhatnagar P K, Shah A, Sarma P U. Identification of 45kD antigen in immune complexes of patients of allergic bronchopulmonary aspergillosis. Mol Cell Biochem. 1997; 166 111-116
34 Crameri R. Molecular cloning of Aspergillus fumigatus allergens and their role in allergic bronchopulmonary aspergillosis. Chem Immunol. 2002; 81 73-93
35 Kurup V P, Grunig G, Knutsen A P, Murali P S. Cytokines in allergic bronchopulmonary aspergillosis. Res Immunol. 1998; 149 466-477
36 Kahn S, McClellan J S, Knutsen A P. Increased sensitivity to IL-4 in patients with allergic bronchopulmonary aspergillosis. Int'l Arch Allergy Immunol. 2000; 123 319-326
37 Chauhan B, Santiago L, Hutcheson P S et al.. Evidence for the involvement of two different MHC class II regions in susceptibility or protection in allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 2000; 106 723-729
38 Cockrill B A, Hales C A. Allergic bronchopulmonary aspergillosis. Annu Rev Med. 1999; 50 303-316
39 Ricketti A J, Greenberger P A, Mintzer R A, Patterson R. Allergic bronchopulmonary aspergillosis. Arch Intern Med. 1983; 143 1553-1557
40 Elliott M W, Taylor J N. Allergic bronchopulmonary aspergillosis. Clin Exp Allergy. 1997; 27(suppl 1) 55-59
41 Greenberger P A, Patterson R. Allergic bronchopulmonary aspergillosis: model of bronchopulmonary disease with defined serologic, radiologic, pathologic and clinical findings from asthma to fatal destructive lung disease. Chest. 1987; 91(suppl) 165S-171S
42 Rosenberg M, Patterson R, Roberts M, Wang J. The assessment of immunologic and clinical changes occurring during corticosteroid therapy for allergic bronchopulmonary aspergillosis. Am J Med. 1978; 64 599-606
43 Greenberger P A, Patterson R. Diagnosis and management of allergic bronchopulmonary aspergillosis. Ann Allergy. 1986; 56 444-448
44 Sahn S A, Lakshminarayan S. Allergic bronchopulmonary penicillosis. Chest. 1973; 63 286-288
45 Hoshino H, Tagaki S, Kon H et al.. Allergic bronchopulmonary aspergillosis due to Aspergillus niger without bronchial asthma. Respiration. 1999; 66 369-372
46 Rajkumar D C. Evaluation of allergic bronchopulmonary aspergillosis in patients with and without central bronchiectasis. J Asthma. 2002; 39 473-477
47 Shah A, Panjabi C. Allergic bronchopulmonary aspergillosis: a review of a disease with a worldwide distribution. J Asthma. 2002; 39 273-289
48 Wark P AB, Gibson P G. Allergic bronchopulmonary aspergillosis: new concepts of pathogenesis and treatment. Respirology. 2001; 6 1-7
49 Capewell S, Chapman B J, Alexander F, Greening A P, Crompton G K. Corticosteroid treatment and prognosis in pulmonary eosinophilia. Thorax. 1989; 44 925-929
50 Safirstein B H, D'Sousa M F, Simon G, Tai E HC, Pepys J. Five-year follow-up of allergic bronchopulmonary aspergillosis. Am Rev Respir Dis. 1973; 108 450-459
51 Middleton W G, Paterson I C, Grant I WB, Douglas A C. Asthmatic pulmonary eosinophilia: a review of 65 cases. Br J Dis Chest. 1977; 71 115-122
52 Wang J L, Patterson R, Roberts M, Ghory A C. The management of allergic bronchopulmonary aspergillosis. Am Rev Respir Dis. 1979; 120 87-92
53 Fink J N. Allergic bronchopulmonary aspergillosis. Chest. 1985; 87(suppl) 81S-84S
54 Rosenberg M, Patterson R, Mintzer R, Cooper B J, Roberts M, Harris K E. Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med. 1977; 86 405-414
55 McCarthy D S, Pepys J. Allergic bronchopulmonary aspergillosis: clinical immunology, II: Skin, nasal and bronchial tests. Clin Allergy. 1971; 1 415-432
56 Report to the Research Committee of the British Thoracic Society . Inhaled beclomethasone dipropionate in allergic bronchopulmonary aspergillosis. Br J Dis Chest. 1979; 73 349-356
57 Hilton A M, Chatterjee S S. Bronchopulmonary aspergillosis: treatment with beclomethasone dipropionate. Postgrad Med J. 1975; 51(suppl 4) 98-103
58 Seaton A, Seaton R A, Wightman A JA. Management of allergic bronchopulmonary aspergillosis. Q J Med. 1994; 87 529-537
59 Leon E E, Craig T J. Antifungals in the treatment of allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol. 1999; 82 511-517
60 Germand P, Tuchais E. Allergic bronchopulmonary aspergillosis treated with itraconazole. Chest. 1995; 107 883
61 Pacheco A, Martin J A, Cuevas M. Serologic response to itraconazole in allergic bronchopulmonary aspergillosis. Chest. 1993; 103 980-981
62 De Beule K, De Doncher P, Cauwenbergh G et al.. The treatment of aspergillosis and aspergilloma with itraconazole, clinical results and open label study (1982-1987). Mycoses. 1988; 31 476-485
63 Chabasse D, Tuchais E, Bouchara J P, De Gentile L, Tuchais N. Efficacite de l'itraconazole dans le traitment de l'aspergillosis broncho-pulmonare allergique (ABPA), a propos de 2 observations. Bull Soc Fr Myc Med. 1990; 19 271-275
64 Nikaido Y, Nagata N, Yamamoto T, Yoshii C, Ohmori H, Kido N. A case of allergic bronchopulmonary aspergilosis successfully treated with itraconazole. Respir Med. 1998; 92 118-119
65 Matsuzaki Y, Jimi T, Tao Y, Takada S, Miyazaki N. Allergic bronchopulmonary aspergillosis successfully treated with itraconazole (Japanese). Nihon Kyobu Shikkan Gakkai Zasshi. 1997; 35 352-356
66 Salez F, Brichet A, Desurmont S, Grosbois J-M, Wallert B, Tuonnel A-B. Effects of itraconazole therapy in allergic bronchopulmonary aspergillosis. Chest. 1999; 116 1665-1668
67 Mannes G P, van der Heide S, van Aalderen W M, Gerritsen J. Itraconazole and allergic bronchopulmonary aspergillosis in two brothers with cystic fibrosis. Lancet. 1993; 341 492
68 Lebeau B, Pelloux H, Pinel C et al.. Itraconazole in the treatment of aspergillosis: a study of 16 cases. Mycoses. 1994; 37 171-179
69 Denning D W, Van Wye J E, Lewiston N J, Stevens D A. Adjunctive therapy of allergic bronchopulmonary aspergillosis with itraconazole. Chest. 1991; 100 813-819
70 Measaki S, Iwakawa J, Higashiyama Y et al.. Antifungal activity of a new triazole, voriconazole (UK-109496), against clinical isolates of Aspergillus spp. J Infect Chemother. 2000; 6 101-103
71 Pfaller M A, Messer S A, Hollis R J, Jones R N. Sentry Participants Group. Antifungal activities of posaconazole, ravuconazole, and voriconazole compared to those of itraconazole and amphotericin B against 239 clinical isolates of Aspergillus spp. and other filamentous fungi: report from SENTRY antimicrobial surveillance program, 2000. Antimicrob Agents Chemother. 2002; 46 1032-1037
72 National Asthma Education and Prevention Program .Expert panel report, 2: Guidelines for the diagnosis and management of asthma; clinical practice guidelines, component 3. Bethesda, MD; National Institutes of Health 1997 Publication no. 97-405
73 Radin R C, Greenberger P A, Patterson R, Ghory A. Mould counts and exacerbations of allergic bronchopulmonary aspergillosis. Clin Allergy. 1983; 13 271-275
74 Hanley-Lopez J, Clement L T. Allergic bronchopulmonary aspergillosis in cystic fibrosis. Curr Opin Pulm Med. 2000; 6 540-544
75 Mastella G, Rainisio M, Harms H K et al.. Epidemiologic Registry of Cystic Fibrosis: allergic bronchopulmonary aspergillosis in cystic fibrosis: a European epidemiological study. Eur Respir J. 2000; 16 464-471
76 Geller D E, Kaplowitz H, Light M, Colin A A. Epidemiologic Study of Cystic Fibrosis: allergic bronchopulmonary aspergillosis in cystic fibrosis: reported prevalence, regional distribution, and patient characteristics. Chest. 1999; 116 639-646
77 Hutcheson P S, Rejent A J, Slavin R G. Variability in parameters of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis. J Allergy Clin Immunol. 1991; 88 390-394
78 Moss R B. Allergic bronchopulmonary aspergillosis. Clin Rev Allergy Immunol. 2002; 23 87-104
79 Skov M, Hoiby N, Koch C. Itraconazole treatment of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis. Allergy. 2002; 57 723-728
80 Miller P W, Hamosh A, Macek M et al.. Cystic fibrosis transmembrane conductance regulator (CFTR) mutations in allergic bronchopulmonary aspergillosis. Am J Hum Genet. 1996; 59 45-51
81 Marchand E, Verellen-Dumoulin C, Maresse M et al.. Frequency of cystic fibrosis transmembrane conductance regulator gene mutations and 5T allele in patients with allergic bronchopulmonary aspergillosis. Chest. 2001; 119 762-767
82 Eaton T E, Weiner Miller P, Garrett J E, Cutting G R. Cystic fibrosis transmembrane conductance regulator gene mutations: do they play a role in the etiology of allergic bronchopulmonary aspergillosis?. Clin Exp Allergy. 2002; 32 756-761
83 Fraser R, Pare J, Pare P et al.. Diagnosis of diseases of the chest. 3rd ed. Philadelphia; WB Saunders 1998
84 British Tuberculosis and Thoracic Association . Aspergilloma and residual tuberculosis cavities: the result of a resurvey. Tubercle. 1970; 51 227-245
85 Libshitz H I, Atkinson G W, Israel H L. Pleural thickening as a manifestation of Aspergillus superinfection. AJR Am J Roentgenol. 1974; 120 883-886
86 Glimp R A, Bayer A S. Pulmonary aspergilloma: diagnostic and therapeutic considerations. Arch Intern Med. 1983; 143 303-308
87 Rafferty P, Biggs B, Crompton G K et al.. What happens to patients with pulmonary aspergilloma?. Thorax. 1983; 38 579-583
88 Andrews C P, Weiner M H. Aspergillus antigen detection in bronchoalveolar lavage fluid from patients with invasive aspergillosis and aspergilloma. Am J Med. 1982; 73 372-380
89 Smith R L, Morelli M J, Aranda C P. Pulmonary aspergilloma diagnosed by fiberoptic bronchoscopy. Chest. 1987; 92 948-949
90 Severo L C, Londero A T, Picon P D, Rizzon C F, Tarasconi J C. Petriellidium boydii fungus ball in a patient with active tuberculosis. Mycopathologia. 1982; 77 15-17
91 Goldberg B. Radiological appearances in pulmonary aspergillosis. Clin Radiol. 1962; 13 106-114
92 Irwin A. Radiology of the aspergilloma. Clin Radiol. 1966; 18 432-438
93 Kathuria S K, Rippon J. Non-Aspergillus aspergilloma. Am J Clin Pathol. 1982; 78 870-873
94 McCarthy D S, Peppys J. Pulmonary aspergilloma: clinical immunology. Clin Allergy. 1973; 3 57-70
95 Wollschlager C, Kahn F. Aspergillomas complicating sarcoidosis: a prospective study of 100 patients. Chest. 1984; 86 585-588
96 Torpoco J O, Yousuffuddin M, Pate J W. Aspergilloma within a malignant pulmonary cavity. Chest. 1976; 69 561-563
97 Makker H, McConnochie K, Gibbs A R. Postirradiation pulmonary fibrosis complicated by aspergilloma and bronchocentric granulomatosis. Thorax. 1989; 44 676-677
98 Solit R W, McKeown J J, Smullens S. The surgical implications of intracavitary mycetomas (fungus balls). J Thorac Cardiovasc Surg. 1971; 62 411-422
99 Joynson D HM. Pulmonary aspergilloma. Br J Clin Pract. 1977; 31 207-216
100 Schwartz J, Baum G L, Straub M. Cavitary histoplasmosis complicated by fungus ball. Am J Med. 1961; 31 692-700
101 Sarosi G A, Silberfarb P M, Saliba N A et al.. Aspergillomas occurring in blastomycotic cavities. Am Rev Respir Dis. 1971; 104 581-584
102 Haslock I. Ankylosing spondylitis. Baillieres Clin Rheumatol. 1993; 7 99-115
103 Bruce R A. A case of pulmonary aspergillosis. Tubercle. 1957; 38 203-205
104 Flye M W, Sealy W C. Pulmonary aspergilloma: a report of its occurrence in two patients with cyanotic heart disease. Ann Thorac Surg. 1975; 20 196-203
105 Aslam P A, Eastridge C E, Hughes F A. Aspergillosis of the lung: an 18-year experience. Chest. 1971; 59 28-32
106 Addrizzo-Harris D J, Harkin T J, McGuinness G et al.. Pulmonary aspergilloma and AIDS. Chest. 1997; 111 612-618
107 Shah A, Khan Z U, Chaturvedi S, Malik G B, Randhawa H S. Concomitant allergic Aspergillus sinusitis and allergic bronchopulmonary aspergillosis associated with familial occurrence allergic bronchopulmonary aspergillosis. Ann Allergy. 1990; 64 507-512
108 Pimentel J C. Pulmonary calcification in the tumor-like form of pulmonary aspergillosis: pulmonary aspergilloma. Am Rev Respir Dis. 1966; 94 208-216
109 Campbell M J, Clayton Y M. Bronchopulmonary aspergillosis: a correlation of clinical and laboratory findings in 272 patients investigated for bronchopulmonary aspergillosis. Am Rev Respir Dis. 1964; 89 186-196
110 Hilvering C, Stevens E AM, Orie N GM. Fever in aspergillus mycetoma. Thorax. 1970; 25 19-24
111 Binder R E, Faling L J, Putatch R D et al.. Chronic necrotizing pulmonary aspergillosis: a discrete clinical entity. Medicine. 1982; 60 109-124
112 Faulkner S L, Vernon R, Brown P P et al.. Hemoptysis and pulmonary aspergilloma: operative versus nonoperative treatment. Ann Thorac Surg. 1978; 25 389-392
113 Lewis M M, Mortelliti M P, Yeager Jr H, Tsou E. Clinical bronchiectasis complicating pulmonary sarcoidosis: a case series of seven patients. Sarcoidosis Vasc Diffuse Lung Dis. 2002; 19 154-159
114 Tomlinson J, Sahn S A. Aspergilloma in sarcoidosis and tuberculosis. Chest. 1987; 92 505-508
115 Tomee J, VanDer Werf T, Latge J et al.. Serologic monitoring of disease and treatment in a patient with pulmonary aspergilloma. Am J Respir Crit Care Med. 1995; 151 199-204
116 Kauffman C. Quandary about treatment of aspergillomas persists. Thorax. 1996; 347 1640
117 Daly R C, Pairolero P C, Piehler J M et al.. Pulmonary aspergilloma: results of treatment. J Thorac Cardiovasc Surg. 1986; 92 981-988
118 Soltanzadeh H, Wychulis A R, Sadr F et al.. Surgical treatment of aspergilloma. Ann Surg. 1977; 186 13-16
119 Jewkes J, Kay P H, Paneth M et al.. Pulmonary aspergilloma: analysis of prognosis in relation to hemoptysis and survey of treatment. Thorax. 1983; 38 572-578
120 Garvey J, Crastnopol P, Weisz D et al.. The surgical treatment of pulmonary aspergillomas. J Thorac Cardiovasc Surg. 1977; 74 642-647
121 Israel H L, Lenchner G S, Atkinson G W. Sarcoidosis and aspergilloma: the role of surgery. Chest. 1982; 82 430-432
122 Kaestel M, Meyer W, Mittelmeier H O et al.. Pulmonary aspergilloma: clinical findings and surgical treatment. Thorac Cardiovasc Surg. 1999; 47 340-345
123 Massard G, Roeslin N, Wihlm J M et al.. Pleuropulmonary aspergilloma: clinical spectrum and results of surgical treatment. Ann Thorac Surg. 1992; 54 1159-1164
124 Conlan A A, Abramor E, Moyes D G. Pulmonary aspergilloma: indications for surgical intervention: an analysis of 22 cases. S Afr Med J. 1987; 71 285-288
125 Battaglini J W, Murray G F, Kaegy B A et al.. Surgical management of symptomatic pulmonary aspergilloma. Ann Thorac Surg. 1985; 39 512-516
126 Kay P H. Surgical management of pulmonary aspergilloma [editorial]. Thorax. 1997; 52 753-754
127 Chen J C, Chang Y L, Luh S P et al.. Surgical treatment for pulmonary aspergilloma: a 28-year experience. Thorax. 1997; 52 810-813
128 Chatzimichalis A, Massard G, Kessler R et al.. Bronchopulmonary aspergilloma: a reappraisal. Ann Thorac Surg. 1998; 65 927-929
129 Oakley R E, Petrou M, Goldstraw P. Indications and outcome of surgery for pulmonary aspergilloma. Thorax. 1997; 52 813-815
130 Giron J M, Poey C G, Fajadet P P et al.. Inoperable pulmonary aspergilloma: percutaneous CT-guided injection with glycerin and amphotericin B paste in 15 cases. Radiology. 1993; 188 825-827
131 Jackson M, Flower C DR, Shneerson J M. Treatment of symptomatic pulmonary aspergillomas with intracavitary instillation of amphotericin B through an indwelling catheter. Thorax. 1993; 48 928-930
132 Munk P L, Vellet A D, Rankin R N et al.. Intracavitary aspergilloma: transthoracic percutaneous injection of amphotericin B solution. Radiology. 1993; 188 821-823
133 Lee K S, Kim H T, Kim Y H et al.. Treatment of hemoptysis in patients with cavitary aspergilloma of the lung: value of percutaneous instillation of amphotericin B. AJR Am J Roentgenol. 1993; 161 727-731
134 Klein J S, Fang K, Chang M C. Percutaneous transcatheter treatment of an intracavitary aspergilloma. Cardiovasc Intervent Radiol. 1993; 16 321-324
135 Yamada H, Kohno S, Koga H et al.. Topical treatment of pulmonary aspergilloma by antifungals. Chest. 1993; 103 1421-1425
136 Hargis J L, Bone R C, Stewart J et al.. Intracavitary amphotericin B in the treatment of symptomatic pulmonary aspergillomas. Am J Med. 1980; 68 389-394
137 Rumbak M, Kohler G, Eastrige C et al.. Topical treatment of life-threatening hemoptysis from aspergillomas. Thorax. 1996; 51 253-255
138 Guleria R, Gupta D, Jindal S K. Treatment of pulmonary aspergilloma by endoscopic intracavitary instillation of ketoconazole. Chest. 1993; 103 1301-1302
139 Kaplan J, Johns C J. Mycetomas in pulmonary sarcoidosis: nonsurgical management. J Hopkins Med J. 1979; 145 157-161
140 Remy J, Arnaud A, Fardou H et al.. Treatment of hemoptysis by embolization of bronchial arteries. Radiology. 1977; 122 33-37
141 Uflacker R, Kaemmerer A, Neves C et al.. Management of massive hemoptysis by bronchial artery embolization. Radiology. 1983; 146 627-634
142 Falkson C, Sur R, Pacella J. External beam radiotherapy: a treatment option for massive hemoptysis caused by mycetoma. Clin Oncol. 2002; 14 233-235
143 Shneerson J M, Emerson P A, Phillips R H. Radiotherapy for massive hemoptysis from an aspergilloma. Thorax. 1980; 35 953-954
144 Mikami M, Nakamura S, Kawakami M. Pulmonary aspergilloma successfully treated with long-term intermittent inhalation therapy with miconazole. Intern Med. 1993; 32 247-250
145 Hammerman K H, Sarosi G A, Tosh F E. Amphotericin B in the treatment of saprophytic forms of pulmonary aspergillosis. Am Rev Respir Dis. 1974; 109 57-62
146 Van Cutsem J, Van Gerven F, Vam De Ven M A et al.. Itraconazole, a new triazole that is orally active in aspergillosis. Antimicrob Agents Chemother. 1984; 26 615-619
147 Jennings T S, Hardin T C. Treatment of aspergillosis with itraconazole. Ann Pharmacother. 1993; 27 1206-1211
148 Campbell J H, Winter J H, Richardson M D et al.. Treatment of pulmonary aspergilloma with itraconazole. Thorax. 1991; 46 839-841
149 Dupont B. Itraconazole therapy in aspergillosis: study in 49 patients. J Am Acad Dermatol. 1990; 23 607-614
150 Impens N, De Greve J, DeBeule K et al.. Oral treatment with itraconazole of aspergilloma in cavitary lung cancer. Eur Respir J. 1990; 3 837-839
151 Tsubura E. Multicenter clinical trial of itraconazole in the treatment of pulmonary aspergilloma. Kekkaku. 1997; 72 557-564
152 Judson M A. Diagnosis and management of aspergilloma. Pulmonary Critical Care Update. 2002; 15 1-14

Marc A JudsonM.D.

Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina

96 Jonathan Lucas St.

Charleston, SC 29425

Email: judsonma@MUSC.edu