Surgical aspects of pulmonary aspergillosis Twenty-one cases of pulmonary aspergillosis managed surgically over a 13 year period in the Missouri State Chest Hospital were reviewed. Postoperative complications occurred in 11 patients (52 per cent) but were mostly manageable by conservative measures. There was one postoperative hospital death due to respiratory failure. With the lack of an effective and safe antifungal drug, resection is the treatment of choice for suitable candidates. In conclusion, some guidelines were drawn for the management of patients with this disease. Salim B. Saab, M.D.,* and Carl Almond, M.D.,** Columbia and Mt. Vernon, Mo. AspergillUS is the generic name coined by Micheli in 1729 for the fungus molds he observed. Virchow- (1856) was the first pathologist to describe the role of aspergilli in human pulmonary disease, but human aspergillosis was discussed in the earlier studies of Sluyter ( 1847) and Bennett (1842) .1-:1 Among the various species identified to date, Aspergillus [umigatus is of particularly growing importance in pathogenicity involv- ing the respiratory system. It is ubiquitous in distribution and saprophytic in nature. The purpose of this paper is to report 21 cases of pulmonary aspergillosis managed surgically at the Missouri State Chest Hos- pital during a 13 year period. We shall re- view the clinical features and hence try to define the present status of surgery in the management of this disease. Materials and methods Between July, 1960, and June, 1973, 21 patients with pulmonary aspergillosis had primary thoracic operations to control the Received for publication May 13, 1974. * Assistant Professor of Surgery, University of Missouri Medical Center, Columbia, Mo. 65201, and Associate Chief of Surgery, Missouri State Chest Hospital, Mt. Vernon, Mo. 65712. **Professor of Surgery; Chief, Section of Thoracic and Cardiovascular Surgery, University of Missouri Medical Center, Columbia, Mo. 65201. infection. The criteria for diagnosis were ( 1) repeated isolation of the organism in sputum cultures and (2) identification and growth of the organism from surgical speci- mens. There were 14 men and 7 women, a ratio of 2: 1. Ages ranged between 23 years and 68 years, with persons between 50 and 59 years having the highest incidence of the disease (48 per cent) (Table I). Hemoptysis, the leading symptom, oc- curred in 62 per cent of the cases. Other symptoms included cough, weight loss, fa- tigue, chest pain, fever, and dyspnea, in decreasing order (Table II). Table III summarizes the diagnostic tests performed. The tuberculin skin test was positive in 52 per cent and the histoplasmin skin test in 58 per cent. Both tests were positive in 29 per cent and both were nega- tive in 20 per cent. The complement fixa- tion test for aspergillosis was done in 13 cases. It was positive in 4 and negative in 9. The fungus was repeatedly grown by sputum culture in 8 of 20 cases (40 per cent); culture was not attempted in 1 patient. The diagnosis was confirmed by histopath- ology of the tissue removed during the operation in 20 patients (95 per cent). There was no tissue specimen in 1 patient who was treated by thoracoplasty. Bron- choscopy yielded positive information in 1 455
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