Aspergilloma of lung Cause of coughing out blood even after a successful treatment of tuberculosis

Dr KK Pandey
Contd from previous issue
This white ball is called in medical terms as ‘Fungal ball’ meaning thereby a ball made up of fungal germs.
How to recognize Aspergilloma of lung ?
1. Multiple episodes of coughing out either frank blood or bloody sputum
2. Sometimes vomiting of blood
3. Episodes of recurrent infections in lung
4. Frequent incidences of fever, cough and breathlessness
5. Development of pain on left or right side of the chest during breathing
Where to go if a patient is suffering from Aspergilloma?
If sometime back you had undergone treatment for tuberculosis or abscess of lung and already got rid of infection but recently you have developed problem of cough or sometimes coughing out blood or bloody sputum, chances are you are in all probability suffering from aspergilloma of lung (Fungal ball disease). In such a situation you should immediately consult a thoracic surgeon. For investigation of a case of aspergilloma lung, the chest x-ray and multi slice CT scan are very important tools. The analysis of sputum and CT guided needle biopsy of fungal ball are important. It is not always essential to have the presence of fungal threads of Aspergillus in the sputum as well as in the substance taken out by needle biopsy of the fungal ball. Besides these, sometimes investigation of bronchoscopy and procedure of bronchial artery embolization too are required. Therefore a patient of ‘aspergilloma’ lung should go to a hospital where facility of all these investigations is available. Before entering a hospital make sure whether the availability  of a full-time thoracic surgeon is there or not.
Surgery is the best treatment for Aspergilloma
If you are suffering from aspergilloma of lung and frequently cough out blood, amount of which sometimes becomes significant, please do not sit idle, immediately consult an experienced thoracic surgeon, otherwise your life will be in danger if ever a catastrophic bleeding occurs. The permanent and successful treatment of aspergilloma of lung is surgery, this fact should be understood very clearly. Unless the part of the lung destroyed by aspergilloma is not taken out of the chest, bleeding will never stop during coughing. This operation is called lobectomy. The small operations like removal of fungal ball or only cleaning of the dead hollow space and filling the dead space with medicines and muscles are not reliably effective. The disadvantages of these small operations are two: firstly it is not a permanent treatment and secondly it increases the possibility of creating pus and infection inside the chest. These small operations are justified only in special conditions where patient is not medically fit for the major operation of lobectomy, for example a very weak, old and malnourished transplant patient admitted in an intensive care unit. This small operation is called ‘cavernostomy’.
Embolization - An effective technique to save the life
Sometimes in emergency, the other method of treatment like Bronchial artery embolization is used. In this procedure the culprit bleeding artery is blocked through angiography in order to control a catastrophic bleeding. But this treatment does not lead to a permanent cure, although this procedure is very effective in saving the life of a patient who might have been dead due to uncontrolled bleeding. It has been observed in seven out of ten patients treated successfully with this procedure, an episode of coughing out blood recurs within a few days or months after the procedure. This technique is undoubtedly very effective in saving the life of the patient in emergency situations. Therefore such patients should always go to a hospital where facility of angiography and artery embolization is available. For these procedure the availability of a D.S.A laboratory (digital subtraction angiography) is very essential in the hospital.
What to do when surgery is not possible ?
In some patients surgery is not possible. In such cases special medicines, like Variconazole and amphotenicin are given intravenously. There medicines are effective only when whole lung is infected with aspergillus and there is no dead space or aspergilloma. Such condition is called in medical term as ‘Invasive aspergillosis’. Only in this condition intravenous administration of drug is effective to some extent. But never forget surgery is the only solution and answer for aspergilloma or ‘fungal ball’ of the lung.
The writer is a Senior Thoracic & Cardiovascular Surgeon, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi. He may be reached at 9911114081, 9810114081 and at [email protected]