Scientific Letter
Cavernostomy in the treatment of pulmonary aspergilloma in a high surgical risk patient
Tratamiento del aspergiloma pulmonar en paciente de alto riesgo quirúrgico: cavernostomía
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Cavernostoma en primeros días postquirúrgicos (C). Cavernostoma tras varios meses con curas locales (D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Gómez Tabales, Daniel Andrades Sardiña, Carmen Sánchez Matás, Sara Monge Blanco, Francisco García Gómez, José Luis López Villalobos, Francisco Javier de la Cruz Lozano, Rafael Manuel Barroso Peñalver, Ana Isabel Blanco Orozco" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Juan" "apellidos" => "Gómez Tabales" ] 1 => array:2 [ "nombre" => "Daniel" "apellidos" => "Andrades Sardiña" ] 2 => array:2 [ "nombre" => "Carmen" "apellidos" => "Sánchez Matás" ] 3 => array:2 [ "nombre" => "Sara" "apellidos" => "Monge Blanco" ] 4 => array:2 [ "nombre" => "Francisco" "apellidos" => "García Gómez" ] 5 => array:2 [ "nombre" => "José Luis" "apellidos" => "López Villalobos" ] 6 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "de la Cruz Lozano" ] 7 => array:2 [ "nombre" => "Rafael Manuel" "apellidos" => "Barroso Peñalver" ] 8 => array:2 [ "nombre" => "Ana Isabel" "apellidos" => "Blanco Orozco" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212920301749" "doi" => "10.1016/j.arbr.2020.07.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920301749?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289620301277?idApp=UINPBA00003Z" "url" => "/03002896/0000005600000009/v2_202010270647/S0300289620301277/v2_202010270647/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212920301750" "issn" => "15792129" "doi" => "10.1016/j.arbr.2020.07.007" "estado" => "S300" "fechaPublicacion" => "2020-09-01" "aid" => "2479" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2020;56:597-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Pleural and pericardial effusion as the only manifestation of IgG4-related disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "597" "paginaFinal" => "599" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Derrame pleural y pericárdico como única manifestación de enfermedad relacionada con IgG4" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1277 "Ancho" => 1674 "Tamanyo" => 413060 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Chest CT image showing left pleural effusion with pulmonary atelectasis. B. Pleural biopsy (hematoxylin-eosin) showing fibrohemorrhagic pleuritis with severe mesothelial hyperplasia and dense plasmocellular infiltrate. C. Pleural biopsy (immunohistochemical staining for IgG) showing abundant IgG-type plasmocellular infiltrate. D. Pleural biopsy (immunohistochemical staining for IgG4) showing marked increase in IgG4-producing plasma cells with areas of > 50 cells per high-power field and an IgG4/IgG ratio of 49%.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mónica Tello-Sánchez, María Soledad Rodríguez-Duque, Claudia Loidi-López, Juan Martín-Arroyo, Miguel Ángel González-Gay, Marta Fernández-Ayala Novo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Mónica" "apellidos" => "Tello-Sánchez" ] 1 => array:2 [ "nombre" => "María Soledad" "apellidos" => "Rodríguez-Duque" ] 2 => array:2 [ "nombre" => "Claudia" "apellidos" => "Loidi-López" ] 3 => array:2 [ "nombre" => "Juan" "apellidos" => "Martín-Arroyo" ] 4 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "González-Gay" ] 5 => array:2 [ "nombre" => "Marta" "apellidos" => "Fernández-Ayala Novo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289620301307" "doi" => "10.1016/j.arbres.2020.04.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289620301307?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920301750?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000009/v1_202009150705/S1579212920301750/v1_202009150705/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1579212920302287" "issn" => "15792129" "doi" => "10.1016/j.arbr.2019.08.022" "estado" => "S300" "fechaPublicacion" => "2020-09-01" "aid" => "2252" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2020;56:595" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "A Case Report on a Patient With Spontaneous Expulsion of Large Foreign Body (Dental Prothesis) Without Complications" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "595" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un caso de expulsión espontánea de un cuerpo extraño grande (prótesis dental) sin complicaciones" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1072 "Ancho" => 1123 "Tamanyo" => 147295 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Postero-anterior view of chest X-ray showing the foreign body (prosthetic teeth – black arrow) in the trachea/left main bronchus. Also, a pacemaker and the pacemaker electrodes are seen. (b) Lateral view of chest X-ray showing the foreign body (prosthetic teeth – black arrow) in the trachea/left main bronchus. Also, a pacemaker and the pacemaker electrodes are seen. (c) Prosthetic teeth hold on hand for scale. (d) Lateral view of chest X-ray showing no foreign body (prosthetic) in the trachea/left main bronchus. Also, a pacemaker and the pacemaker electrodes are seen.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "João Pedro Neiva Machado, José Coutinho Costa, Teresa Costa" "autores" => array:3 [ 0 => array:2 [ "nombre" => "João Pedro" "apellidos" => "Neiva Machado" ] 1 => array:2 [ "nombre" => "José Coutinho" "apellidos" => "Costa" ] 2 => array:2 [ "nombre" => "Teresa" "apellidos" => "Costa" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920302287?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000009/v1_202009150705/S1579212920302287/v1_202009150705/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Cavernostomy in the treatment of pulmonary aspergilloma in a high surgical risk patient" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "596" "paginaFinal" => "597" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan Gómez Tabales, Daniel Andrades Sardiña, Carmen Sánchez Matás, Sara Monge Blanco, Francisco García Gómez, José Luis López Villalobos, Francisco Javier de la Cruz Lozano, Rafael Manuel Barroso Peñalver, Ana Isabel Blanco Orozco" "autores" => array:9 [ 0 => array:4 [ "nombre" => "Juan Gómez" "apellidos" => "Tabales" "email" => array:1 [ 0 => "j.gomez.tabales@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Daniel Andrades" "apellidos" => "Sardiña" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => 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"nombre" => "José Luis López" "apellidos" => "Villalobos" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Francisco Javier de la Cruz" "apellidos" => "Lozano" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "Rafael Manuel Barroso" "apellidos" => "Peñalver" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 8 => array:3 [ "nombre" => "Ana Isabel Blanco" "apellidos" => "Orozco" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad Médico-Quirúrgica de Enfermedades Respiratorias (UMQUER), Servicio de Cirugía Torácica, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento del aspergiloma pulmonar en paciente de alto riesgo quirúrgico: cavernostomía" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1246 "Ancho" => 1674 "Tamanyo" => 256949 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial (A) and coronal (B) slices of the pulmonary cavity occupying practically the entire right upper lobe. Cavernostoma in the first few postoperative days (C). Cavernostoma after several months of topical treatment (D).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Aspergilloma is the most frequent cause of lung involvement by <span class="elsevierStyleItalic">Aspergillus</span> (50%). Its incidence is unknown, and the most common predisposing factor is the presence of a cavity previously caused by tuberculosis, observed in up to 70%–80% of cases. The aspergilloma is formed when these cavities are colonized by certain species of <span class="elsevierStyleItalic">Aspergillus</span>, the most common in humans being <span class="elsevierStyleItalic">Aspergillus fumigatus</span>. Systemic or intracavitary antifungal drugs, which have poor penetration into cavitary lesions, only play an adjunct role in treatment and are ineffective in eradicating the microorganism.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Surgery, therefore, can completely eliminate the cavity and reduce associated complications, although this approach is controversial due to the high incidence of postoperative morbidity and mortality described in the literature.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 79-year-old man, recipient of a liver transplant 30 years previously due to chronic HCV-induced liver disease in a situation of chronic rejection. The patient underwent atypical lung resection for tuberculosis in 1970, and presented residual fibrotic lesions in the right lung. He was admitted in 2016 due to hemoptoic expectoration. After sputum smear and culture were found to be positive for mycobacteria, he was diagnosed with infection by <span class="elsevierStyleItalic">Mycobacterium szulgai</span> and treated with rifampicin, clarithromycin and ethambutol for 12 months, with good response and negative sputum. One year later, he was admitted for massive hemoptysis associated with a cavitated lesion in the right upper lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A, B) that persisted despite bronchial artery embolization and morphine hydrochloride perfusion. He also presented severe malnourishment that required nutritional support through a nasogastric tube prior to surgery and for several weeks thereafter.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the risk associated with lung resection, the peripheral location of the lesion, and the likelihood of pleural adhesions and mediastinal fibrosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A, B), we decided to perform cavernostomy in the right upper lobe - a far less aggressive procedure that has been proven effective for the control of infection and hemoptysis in the literature. An incision was made at the level of the second rib and a fragment of bone was resected from the anterolateral portion of that rib. The walls of the cavity were debrided to remove all the necrotic tissue, the interior was cleaned thoroughly and the edges of the incision were invaginated into the cavity. The cavity wound was treated with occlusive dressings of gauze impregnated with amphotericin B applied via the cavernostomy, intravenous amphotericin B was administered for 14 days, and nebulized amphotericin B was maintained after discharge. <span class="elsevierStyleItalic">Aspergillus niger</span> was isolated from the culture of the surgical sample, but postoperative cultures were negative. The patient was discharged after 3 weeks in good clinical condition, and currently continues with daily local treatment of the cavernostomy in the health center and periodic follow-up by the Thoracic Surgery and Pulmonology service.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The main problem encountered during follow-up has been the persistence of air leaks from the cavernostomy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D) that has prevented us from using negative pressure therapies, since they would only worsen the leakage. We also ruled out performing myoplasty to close the cavernostomy, as this procedure would have been impractical due to the patient’s loss of muscle mass. One option we considered was the use of endobronchial valves to obliterate the bronchus or segmental bronchi affected by the persistent air leak; however, the patient refused to undergo additional procedures.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The literature on the surgical treatment of aspergilloma is essentially based on case series. The most frequent indications for surgery are hemoptysis refractory to conservative treatment and diagnosis in asymptomatic patients. The most widely performed procedure in all published series is lobectomy, followed by sublobular resection and bilobectomy or pneumonectomy. Cavernoplasty or cavernostomy is the last option in all reports, and has received little attention in the literature. The postoperative complication rate is 20%–30%, and immediate postoperative mortality is 5%–10%.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Cases series describing intracavitary administration of antifungals and even removal of the aspergilloma using flexible bronchoscopy have been published.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Lung resection, either in the form of pneumonectomy, lobectomy, or wedge resection, is the technique of choice in patients with good baseline status and acceptable surgical risk. Cavernostomy can give adequate control of infection and hemoptysis, and is an option in patients with high surgical risk, such as the case we describe. However, it is not without complications, particularly bleeding, and requires close, long-term monitoring with topical treatment.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">No funding was received.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-10-14" "fechaAceptado" => "2020-04-17" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Tabales JG, Sardiña DA, Matás CS, Blanco SM, Gómez FG, Villalobos JLL, et al. Tratamiento del aspergiloma pulmonar en paciente de alto riesgo quirúrgico: cavernostomía. Arch Bronconeumol. 2020;56:596–597.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1246 "Ancho" => 1674 "Tamanyo" => 256949 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial (A) and coronal (B) slices of the pulmonary cavity occupying practically the entire right upper lobe. Cavernostoma in the first few postoperative days (C). Cavernostoma after several months of topical treatment (D).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-surgical treatment options for pulmonary aspergilloma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Lang" 1 => "A.L. Lang" 2 => "N. Chauhan" 3 => "A. 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