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• W4387249818 abstract "SESSION TITLE: Lung Pathology Case Report Posters 9 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: Presentation of Pulmonary Aspergillosis, a fungal infection found in immunocompromised patients, is varied, and can present as a benign fungal ball or as invasive cavitary, necrotizing, or fibrosing lung disease. We present a case of a young male with history of tuberculous infection and chronic cavitary aspergillosis with multiple admissions of self-resolving hemoptysis and the need for early referral for surgical intervention as a life-saving measure. CASE PRESENTATION: 41 year old Haitian-American male with past medical history of treated pulmonary TB with RIPE, chronic bronchiectasis, and chronic cavitary aspergillosis on voriconazole treatment, was admitted to MICU for acute episode of moderate hemoptysis. Patient was afebrile and hemodynamically stable at time of presentation. Imaging revealed left upper lobe cavity with aspergilloma, bronchiectasis, and fibrotic lung parenchymal changes. He was transferred to a facility for lobectomy for high clinical suspicion of rapid deterioration as he had been admitted in the past for episodes of self resolving recurrent hemoptysis. Patient had an episode of life threatening massive hemoptysis within an hour of transfer and was emergently taken for surgical intervention (upper lobe lobectomy). Patient recovered clinically and follow up revealed complete resolution of hemoptysis. DISCUSSION: 5-14% of patients with hemoptysis may result in life threatening massive hemoptysis. [1] In patients with aspergillosis with hemoptysis in whom bronchial artery embolization cannot be performed due to lack of time, resources, or contraindications, lung resection surgery is considered first line treatment. [2] Though surgical resection mostly improves prognosis in patients with massive hemoptysis and resection has high rate of infection, hemorrhage, bronchopleural fistula, research of 14 patient with post -tuberculous complex aspergilloma with hemoptysis from whom 12 underwent lobectomy and pneumonectomy for recurrent hemoptysis showed resolution of symptoms and no increased dyspnea. [3] In emergent situations, patients are immediately taken for urgent lung resection, but early referral should be considered even in patients with stable recurrent hemoptysis as they have high risk of sudden deterioration. [4] CONCLUSIONS: Early referral for surgical intervention for patients with cavitary aspergillosis with recurrent stable hemoptysis can be life-saving measure due to high risk of sudden clinical deterioration. Surgical treatment options including lobectomy can be perforned electively in stable patients if medical management fails. REFERENCE #1: Kathuria H, Hollingsworth HM, Vilvendhan R, Reardon C. Management of life-threatening hemoptysis. J Intensive Care. 2020 Apr 5;8:23. doi: 10.1186/s40560-020-00441-8. PMID: 32280479; PMCID: PMC7132983. REFERENCE #2: Giang NT, Dung LT, Hien NT, Thiet TT, Hiep PS, Pho DC, Hung PN. Plombage for Hemoptysis Control in Pulmonary Aspergilloma: Safety and Effectiveness of Forgettable Surgery in High-Risk Patients. Ann Thorac Cardiovasc Surg. 2021 Feb 20;27(1):10-17. doi: 10.5761/atcs.oa.20-00169. Epub 2021 Jan 6. PMID: 33408306; PMCID: PMC8043030. REFERENCE #3: al-Majed SA, Ashour M, el-Kassimi FA, Joharjy I, al-Wazzan A, al-Hajjaj MS, Vijay R. Management of post-tuberculous complex aspergilloma of the lung: role of surgical resection. Thorax. 1990 Nov;45(11):846-9. doi: 10.1136/thx.45.11.846. PMID: 2256012; PMCID: PMC462781. DISCLOSURES: No relevant relationships by Jagadish Akella No relevant relationships by Shiva Arjun No relevant relationships by Vaishali Mehta No relevant relationships by Raghavendra Sanivarapu" @default.
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• W4387249818 date "2023-10-01" @default.
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• W4387249818 title "CHRONIC CAVITARY ASPERGILLOSIS: WHEN TO INTERVENE WITH MASSIVE HEMOPTYSIS" @default.
• W4387249818 doi "https://doi.org/10.1016/j.chest.2023.07.2976" @default.
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