• Journal of Chest Surgery
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• v.29 no.11
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• pp.1232-1240
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• 1996

From January 1990 through June 1995, we operated on 121 patients who were suspected for pulmonary tuberculosis without definite final diagnosis. After operation the final pathologic diagnoses were as follows: 68 pulmonary tuberculosis in which 29 were tuberculoma, 23 lung cancer, 16 bronchiectasis, 6 aspergilloma, 2 lung abscess, 2 benign cyst and 4 others. In 121 cases, 81 were male and 40 were female and the peak age incidence was 4th decade in tuberculosis (39.7%) and 6th and 7th decade in lung cancer (69.6%). The diagnoses in 44 cases presented roentgenographically as pulmonary nodules were pulmonary tuberculosis(29 cases) and lung cancer(15 cases). Tuberculous nodules tended to be smaller in size with calcification and satellite lesions compared to carcinomas. Indications for operation were solitary nodules 44 cases (36.4%); destroyed lobe 31(25.6%); hemoptysis 25 (20.7%); cavitary lesion 11(9.1 %); bronchostenosis 3 (2.5%); destroyed lung 5(4.1 %) and destroyed lung with empyema 2(1.7%). We conclude that preoperatively suspected pulmonary tuberculosis should be distinguished from various pulmonary lesions such as carcinoma, bronchiectasis, aspergilloma, lung abscess and benign cyst. For the possibility of carcinoma, pulmonary nodules of size greater than 3cm, non-calcified, non satellite lesion, newly developed nodule even under the anti-tuberculous medication, negative PPD skin test with elevated CEA level are recommended for an early resectional surgery and follow-up and delayed surgery is recommended in cases such as pulmonary nodules less than 3 cm in size with calcification, satellite lesion, positive PPD skin reaction and elevated ESR, CRP, ALP levels.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.530-535
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• 1996

Saprophytic aspergillosis (aspergilloma), a potentially life-threatening disease from the colonization of lung cavities by the ubiquitous fungus Aspergillus fumigatus, has been of surgical concern. Twelve patients with symptomatic aspergilloma underwent operative procedures at Pusan national University Hospital between January 1, 1984 and August 31, 1994. The mean age of the patients was 38.8 years and nine of them had hemoptysis; in two it was massive and life-threatening. Wine of the patients had underlying causes of cavitary lung disease and tuberculosis was the most common cause. Lobectomy was the most commonly performed procedure (in six) . Several major complications including excessive bleeding (2), and pneumonia (2), and empyema with bronchopleural fistula (1) occurred .and one patient died (operative mortality=8.3%). There were no recurrent symptoms in any of the 11 operative survivors during the follow-up period. It is concluded that early, aggressive surgical intervention can provide definite cure in established aspergilloma, even with minimal symptoms.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.497-503
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• 2003

Pulmonary aspergillosis usually results from the colonization of the existing lung lesions by chronic pulmonary diseases, such as tuberculosis. Most cases of pulmonary aspergilloma have been treated surgically for many years because it is a potentially life-threatening disease causing massive hemoptysis. Here we reviewed our results from the last 10 years. Material and Method: We reviewed 31 cases surgically treated from Aug. 1992 to Jul. 2002. retrospectively. This investigation is designed to illustrate the peak age incidence, sex ratio, chief complaints, preoperative study, anatomic location of operative site, postoperative pathologic finding and postoperative complications. Result: The peak age Incidence laid in the 3rd and 4th decade of 20 cases (64.5%). The most common complaint was hemoptysis in 27 cases (87.1%). The 31 cases had a history of treatment with anti-tuberculous drugs under impression of pulmonary tuberculosis. The 19 cases (61.3%) showed the so-called “Air-meniscus sign” on the preoperative chest X-ray. In the 31 cases (100%) on the chest computed tomography. as a preoperative diagnostic modality, positivity was shown in 37.9%, 83.3% was shown on the fungus culture of sputum for Aspergillus, serum immunodiffusion test for A. fumigatus, respectively. The anatomical location of aspergilloma was mainly in the upper lobe in 19 cases (61.3%) and the majority of cases were managed by lobectomy. The postoperative pathologic findings showed that 31 cases (100%) were combined with tuberculosis. The postoperative complications include empyema, prolonged air leakage, remained dead space, postoperative bleeding and these numbers of cases is 3 cases (9.7%), 2 cases (6.45%), 2 cases (6.45%), 1 case (3.23%), respectively. one case was died postoperatively due to massive beeding, and asphyxia. Conclusion: Compared with the previous study, there is no significant difference in results. Preoperative chest computed tomography and immunodiffusion test were more commonly available and showed high positivity. Operations often became technically difficult because of pleural space obliteration, indurated hilar structures, and poor expansion of the remaining lung, which were more prominent in the patients with complex aspergillosis. In such cases, medical treatments and interventional procedures like bronchial artery embolization are preferred. However, cavernostomy is also recommanded with few additional morbidity because of its relatively less invassiveness. Early surgical intervention is the recommended management for patients with simple aspergilloma considering the Row surgical mortality and morbidity in recent days.

• Journal of Chest Surgery
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• v.37 no.12
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• pp.1022-1024
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• 2004

Pulmonary aspergillosis is the most common disease of fungal infection and has lower infectivity. Pulmonary asergillosis is classified by aspergilloma, bronchopulmonary aspergillosis, necrotic and invasive aspergillosis. Invasive aspergillosis is found in immune compromised host, immunosuppressive treatment after organ transplantation, anticancerous chemotherapy, blood abnormality, AIDS patients etc. We reported a case of invasive aspergillosis in an immunocompetent host, with review of literatures.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1058-1062
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• 1995

We have experienced one case of hemoptysis which developed from both upper lung fields due to pulmonary aspergilloma combined with pulmonary tuberculosis. A 48 year old female patient was admitted with 10 years history of recurrent hemoptysis. Chest X-ray film revealed moderately advanced active pulmonary tuberculosis lesion on both upper lung fields, and cresentic radiolucent space between cavity wall and round radiopaque lesion on left upper lung field. Bronchial arteriogram showed hypervascularity and extravasation of contrast media in the right lung and it was treated by bronchial artery embolization. Hemoptysis recurred 7 months after embolization and repeat examination revealed greatly increased bronchial vasculature in the left upper lobe and therefore underwent left upper lobectomy. The pathologic result was compatible with aspergillosis, and the postoperative recovery was uneventful.

• Journal of Chest Surgery
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• v.22 no.1
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• pp.170-175
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• 1989

Eleven cases of pulmonary resection had been performed for pulmonary aspergilloma in the department of thoracic and cardiovascular surgery, School of Medicine, Kyungpook National University from August 1984 to July 1988. The patients were consisted of six males and five females and were evenly distributed from third decade to sixth decade. Hemoptysis was usually presenting symptom [72.2%] and the variable was the interval between symptom onset to surgical resection, which was ranged from few months to several years In the plane chest films, intracavitary fungus balls were noted in five cases [5/11] and upper lobe involvements were seven cases [7/11]. Aspergillus fumigatus was identified preoperatively in three cases among the eight cases of sputum culture. Mean preoperative FVC and FEV 1.0 values were in normal range. Eleven pulmonary resections were done by eight lobectomies, two segmentectomies and one pneumonectomy. The lesion was superimposed upon old tuberculosis in eight patients, in one upon bronchiectasis and in two upon tuberculous bronchiectasis. Five complications appeared postoperatively which included ARDS [1 case] bleeding [2 cases], persistent air leak[1 case], and dead space [1 case].

• Tuberculosis and Respiratory Diseases
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• v.74 no.3
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• pp.111-119
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• 2013

Background: Hemoptysis due to pulmonary tuberculosis (TB) frequently develops in Korea where the prevalence of TB is intermediate. The effect of bronchial artery embolization (BAE) on the control of massive hemoptysis has been well known. This study is designed to identify the risk factors contributing to rebleeding after BAE in patients with TB. Methods: We retrospectively evaluated risk factors and the time for rebleeding after BAE in 72 patients presenting with hemoptysis. Results: The overall immediate success rate of BAE was 93.1% (67 of 72 patients). Of the 29 patients (40.3%) who showed rebleeding after BAE, 13 patients experienced rebleeding within 1 month, and 14 patients between 1 month to 1 year. The existence of a shunt in angiographic finding, aspergilloma, and diabetes mellitus were risk factors of rebleeding after BAE in multivariate analysis. Conclusion: BAE was very effective for obtaining immediate bleeding control in hemoptysis associated with active TB or post-TB sequelae. It is important to observe whether or not rebleeding occurs up to 1 year of BAE especially in TB patients with aspergilloma, DM, or a shunt. Even rebleeding can be managed well by second BAE.

• Tuberculosis and Respiratory Diseases
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• v.70 no.1
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• pp.58-62
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• 2011

Pulmonary siderosis is a pneumoconiosis caused by chronic iron inhalation. A diagnosis of pulmonary siderosis is based on a patient history of iron inhalation, on chest radiographic findings, and on accumulation of iron oxide in macrophages within the lung. A typical radiographic finding of pulmonary siderosis includes ill-defined micronodules that are diffusely distributed in the lung. We experienced a 52-year-woman with a $1.3{\times}1.5$-cm mass in the left upper lobe with multiple nodules in both lungs. Because the radiographic findings were atypical, we conducted a video-assisted thorascopic lung biopsy procedure to exclude the diagnosis of metastatic lung cancer. After confirming iron deposition in the lung tissue and knowing the patient's occupational history of welding iron, we concluded that this was a case of pulmonary siderosis.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.139-142
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• 1976

A 33 year old male patient was admitted with 20 years history of recurrent hemoptysis. On clinical examination, mild left chest discomfortness and foul odored sputum with occasional rusty hemoptysis were principal complaints noted. Chest X-ray film revealed moderately advanced active tuberculosis lesion on both upper lung fields, and hen-egg sized mass surrounded with linear crescent of air shadow in a cavity on his left upper lung field. On left thoracotomy, dense pleural adhesions on left apicoposterior segmental surface with multiple lymphnode enlargements were noted, and the soft encapsulated mass of $5{\times}5{\times}8cm$ was localized in the apicoposterior segment of the left upper lobe. Apicoposterior segment with anterior segment of the left upper lobe was resected. Cavity was opened to find a rusty grayish colored, fragile mass, which was confirmed as "fungus ball" of aspergillosis by histological section slide with Gomori staining. The authors report one case of pulmonary aspergilloma superinfected with previous long standing pulmonary tbc.

• Tuberculosis and Respiratory Diseases
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• v.46 no.2
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• pp.260-265
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• 1999

The first case of allergic bronchopulmonary aspergillosis(ABPA) was reported by Hinson, et al. in 1952. This was followed by a number of significant description of the disorder. Although typical ABP A initially presents with asthma, fleeting pulmonary infiltrates, and marked eosinophilia, there are many other ways in which the disease may be first manifested. Common radiologic findings in ABP A include pulmonary infiltrates, atelectasis, emphysema, fibrosis, lobar shrinkage with hilar elevation, cavitation, pneumothorax, aspergilloma and central bronchiectasis. We experienced a case of allergic bronchopulmonary aspergillosis presenting rare radiologic finding of bilateral pulmonary masses in chest radiography. With oral corticosteroid treatment, the size of both pulmonary masses was decreased significantly and his asthmatic symptoms were improved.