C-Arm Fluoroscopy-Guided Bronchoscopic Biopsy for Diagnosing Aspergilloma With Massive Hemoptysis After Pulmonary Tuberculosis: A Case Report

Rifka Wikamto, I Dewa Putu Ardana, Suhendro Suhendro

Abstract


Background: Aspergilloma usually develops in the pulmonary cavity that already exists, including tuberculosis. The most frequent symptom is hemoptysis. Diagnosis of proven fungal infection requires a tissue sample obtained from a disease location to be subjected to histological examination or culture. A specimen taken using bronchoscopy alone is quite challenging because of its location. In this case, a C-arm fluoroscopy-guided bronchoscopic biopsy may be a solution to get specimens for a proven diagnosis.

Case: A 53-year-old male presented to the emergency department following a massive hemoptysis with a previous history of tuberculosis. Chest radiography revealed opacity and hilar restriction in the left upper lobe. A chest CT scan without contrast revealed suspected aspergilloma. The patient underwent a C-arm fluoroscopy-guided bronchoscopy for a biopsy sample. The biopsy sample referred to Aspergillus niger.

Discussion: Aspergillus sp. leads to parenchymal damage and causes several symptoms, mostly hemoptysis. Aspergilloma usually develops in the pulmonary cavity that already exists, including those from tuberculosis. The diagnostic effectiveness of bronchoscopy guided by C-arm fluoroscopy for peripheral lung lesions has consistently improved.

Conclusion: Aspergilloma usually develops in the pulmonary cavity that already exists, including tuberculosis. The patient came to the emergency department with massive hemoptysis and met all the criteria for diagnosis of proven fungal infection. The diagnosis was made by analyzing biopsy samples, which was taken by C-arm fluoroscopy-guided bronchoscopy.


Keywords


Aspergilloma, C-arm fluoroscopy-guided bronchoscopy, post-treatment tuberculosis, massive hemoptysis

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References


Rozaliyani A, Jusuf A, ZS P, et al. Infeksi jamur paru di Indonesia: Situasi saat ini dan tantangan di masa depan. Jurnal Respirologi Indonesia 2019;39(3):210–214.

Lee SH, Lee BJ, Jung DY, et al. Clinical manifestations and treatment outcomes of pulmonary aspergilloma. Korean J Intern Med 2004;19(1):38.

Hayes GE, Novak-Frazer L. Chronic pulmonary aspergillosis-Where are we? and where are we going? J Fungi (Basel) 2016;2(2):18.

Harmouchi H, Sani R, Issoufou I, Lakranbi M, Ouadnouni Y, Smahi M. Pulmonary aspergilloma: From classification to management. Asian Cardiovasc Thorac Ann 2020;28(1):33–38.

Karlafti E, Tsavdaris D, Kotzakioulafi E, et al. Which is the best way to treat massive hemoptysis? A systematic review and meta-analysis of observational studies. J Pers Med 2023;13(12):1649.

Ding WY, Chan T, Yadavilli RK, McWilliams R. Aspergilloma and massive haemoptysis. BMJ Case Rep 2014;2014.

Chakraborty RK, Gilotra TS, Tobin EH, Baradhi KM. Aspergilloma. Treasure Island (FL): StatPearls Publishing, 2024;

Pauw B De, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46(12):1813–1821.

Emre JÇ, Baysak A, Öz AT, Çok G, Göksel T. Endobronşiyal lezyon saptanmayan olgularda C kollu skopi eşliğinde yapılan bronkoskopinin tanı değeri. Journal of Clinical and Analytical Medicine 2016;7(4):449–453.

Perhimpunan Dokter Paru Indonesia. Panduan umum praktik klinis penyakit paru dan pernapasan. Jakarta: Perhimpunan Dokter Paru Indonesia, 2021;

Lang M, Lang AL, Chauhan N, Gill A. Non-surgical treatment options for pulmonary aspergilloma. Respir Med 2020;164:105903.

Gupta PR, Jain S, Kewlani JP. A comparative study of itraconazole in various dose schedules in the treatment of pulmonary aspergilloma in treated patients of pulmonary tuberculosis. Lung India 2015;32(4):342–346.

Maturu V, Agarwal R. Itraconazole in chronic pulmonary aspergillosis: In whom, for how long, and at what dose? Lung India 2015;32(4):309–312.

Hosseini M, Shakerimoghaddam A, Ghazalibina M, Khaledi A. Aspergillus coinfection among patients with pulmonary tuberculosis in Asia and Africa countries; A systematic review and meta-analysis of cross-sectional studies. Microb Pathog 2020;141:104018.

Bongomin F. Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern. PLoS Pathog 2020;16(8):e1008742.

Atchade E, Jean-Baptiste S, Houzé S, et al. Fatal invasive aspergillosis caused by Aspergillus niger after bilateral lung transplantation. Med Mycol Case Rep 2017;17:4–7.

Person AK, Chudgar SM, Norton BL, Tong BC, Stout JE. Aspergillus niger: An unusual cause of invasive pulmonary aspergillosis. J Med Microbiol 2010;59(Pt 7):834–838.

Kokkonouzis I, Athanasopoulos I, Doulgerakis N, et al. Fatal hemoptysis due to chronic cavitary pulmonary aspergillosis complicated by nontuberculous mycobacterial tuberculosis. Case Rep Infect Dis 2011;2011:1–4.

Soedarsono, Widoretno ETW. Aspergilloma pada tuberkulosis paru. Jurnal Respirasi 2017;3(2):58–65.

Kim TH, Koo HJ, Lim CM, et al. Risk factors of severe hemoptysis in patients with fungus ball. J Thorac Dis 2019;11(10):4249–4257.

Kasprzyk M, Pieczyński K, Mania K, Gabryel P, Piwkowski C, Dyszkiewicz W. Surgical treatment for pulmonary aspergilloma - early and long-term results. Kardiochir Torakochirurgia Pol 2017;14(2):99–103.

Khan MA, Dar AM, Kawoosa NU, et al. Clinical profile and surgical outcome for pulmonary aspergilloma: nine year retrospective observational study in a tertiary care hospital. Int J Surg 2011;9(3):267–271.

Akbari JG, Varma PK, Neema PK, Menon MU, Neelakandhan KS. Clinical profile and surgical outcome for pulmonary aspergilloma: A single center experience. Ann Thorac Surg 2005;80(3):1067–1072.

Chen QK, Jiang GN, Ding JA. Surgical treatment for pulmonary aspergilloma: A 35-year experience in the Chinese population. Interact Cardiovasc Thorac Surg 2012;15(1):77–80.

P G, Aruna V, R M, S K, Devesh K, S J. Role of itraconazole in the management of aspergillosis in treated patients of pulmonary tuberculosis. Lung India 2005;22(3):81–85.




DOI: https://doi.org/10.36497/jri.v44i2.529

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