Surgery in pulmonary aspergillosis Pulmonary aspergillosis is a rare disease, most commonly presenting as secondary invasion of pre-existing cavitary disease. In Toronto General Hospital 24 patients have been recognized as having this disorder in the 10 years from 1965 to 1975. The most common presenting symptoms were cough, sputum production, and hemoptysis, with the hemoptysis occasionally being massive. Tuberculosis and bronchiectasis were the commonest pre-existing diseases. Thirteen of these patients were treated by surgical resection because of major complications or progression of the aspergillosis. Five of these patients died following surgery, all of these having had major complications prior to surgical intervention. OJ the eight surviving patients seven are progressing well, but one has developed further extension of his disease. R. D. Henderson, 1. Deslaurier, E. L. Ritcey, N. C. Delarue, and F. G. Pearson, Toronto, Ontario, Canada The fungus Aspergillus [umigatus, despite its ubiquitous nature, very rarely gives rise to human infection. The first recognized aspergillosis infection was reported by Sluy- ter' in 1847 and the first operative resection of an aspergilloma was carried out by Gerstl, Wideman, and Newmann- in 1948. Kilman and associates" in 1969 reviewed the world literature and reported a total of only 70 resections, adding 14 further cases of his own. This rare disease continues to present as a major therapeutic challenge. Case material Twenty-four patients have been diag- nosed as having aspergillosis at the Toronto General Hospital between the years 1965 to 1975. The average age of these patients is 42 years, 15 are male and 9 female. In all cases a diagnosis was made either by sputum culture or by the recognition of Aspergillus [umigatus in a resected speci- men. From the Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Read at the First Annual Meeting of The Samson Thoracic Surgical Society, Santa Barbara, Calif., May 28-30, 1975. Address for reprints: Dr. R. D. Henderson, Rm 139, Uni- versity Wing, Toronto General Hospital, Toronto, Ontario, M5G IL7, Canada. 1088 Twenty patients had cough and sputum production and in three of these the sputum production was massive. Eleven patients had hemoptysis and in four of these the hemoptysis was recurrent and massive. Other symptoms which occurred included pyrexia in four patients, weight loss in excess of 50 pounds in 4, and chest pain localized to the site of major involvement in 5 (Table I). In those with massive sputum production the sputum had an offensive taste and odor and produced considerable distress to the patient. Although in many the hemoptysis was marked and distressing, in only four was it characterized as being massive and in these four patients bleeding episodes of several hundred cubic centimeters occurred, producing acute respiratory distress in two patients, in one a respiratory arrest requiring emergency bronchoscopy and suction, and in one a cardiac arrest. All patients had chest x-rays. In most patients tomograms were also performed and in a few more complicated radiological studies such as bronchography and pul- monary angiography were carried out. On reviewing the radiological studies 12 were considered to be nonspecific, showing dif- fuse lung infiltration which was not suffi-
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