From the Guidelines
Hemoptysis in aspergilloma should be managed with surgical resection as the definitive treatment for recurrent significant hemoptysis, assuming the patient's respiratory function permits, as recommended by the 2016 update by the Infectious Diseases Society of America 1.
Management of Hemoptysis in Aspergilloma
The management of hemoptysis in aspergilloma involves a step-wise approach, considering the severity of hemoptysis and the patient's underlying health status.
- For mild hemoptysis, conservative measures such as bed rest, cough suppression with codeine, and correction of any underlying coagulopathy are recommended.
- For moderate to severe hemoptysis, hospitalization is necessary with consideration for bronchial artery embolization as a first-line interventional approach, as suggested by the practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America 1.
Antifungal Therapy
Antifungal therapy with oral itraconazole or voriconazole may be used in selected cases but generally has limited efficacy for established aspergillomas.
- Oral itraconazole and voriconazole are the preferred oral antifungal agents, as recommended by the practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America 1.
Surgical Resection
Surgical resection of the aspergilloma is the definitive treatment for recurrent significant hemoptysis, typically through lobectomy or segmentectomy, when the patient's respiratory function permits, as recommended by the 2016 update by the Infectious Diseases Society of America 1.
- The outcomes from surgery are less favorable than those with single aspergilloma, and a careful risk assessment prior to surgical intervention is required, as noted in the practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America 1.
From the Research
Treatment Options for Hemoptysis in Aspergilloma
- Percutaneous intracavitary instillation of amphotericin B has been shown to be an effective treatment for severe hemoptysis caused by pulmonary aspergilloma, with a success rate of 85% in controlling hemoptysis 2.
- This treatment method involves the insertion of a catheter into the aspergilloma cavity, followed by the instillation of amphotericin B, which has been shown to be effective in stopping hemoptysis in patients with severely compromised pulmonary reserve 3.
- Endobronchial amphotericin B has also been used to treat hemoptysis in patients with aspergillosis, with successful cessation of hemoptysis and resolution of the aspergilloma 4.
- Other treatment options include the use of sodium or potassium iodide, which have been shown to be effective in stopping hemoptysis in patients with pulmonary aspergilloma, with no reported morbidity or mortality 5.
Potential Risk Factors for Recurrent Hemoptysis
- An increase in size or reappearance of the aspergilloma on a chest CT scan has been identified as a potential risk factor for recurrent hemoptysis 2.
- Bleeding diathesis and lack of bronchial artery embolization during index hospitalization have also been identified as potential risk factors for recurrent hemoptysis 2.
- The long-term benefit of percutaneous intracavitary instillation of amphotericin B is unknown, and further studies are needed to determine the effectiveness of this treatment method in preventing recurrent hemoptysis 2, 3, 6.
Complications and Side Effects
- Pneumothorax has been reported as a complication of percutaneous intracavitary instillation of amphotericin B, occurring in 26% of catheter placement attempts 2.
- Mild hemoptysis during the procedure, small pneumothorax, and subcutaneous emphysema have also been reported as complications of this treatment method 6.
- Slight irritation on instillation of the iodide solution and occasional cough have been reported as side effects of treatment with sodium or potassium iodide 5.