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Treatment of complicated pulmonary aspergillomas with cavernostomy and muscle flap: interest of concomitant limited thoracoplasty

Thoracic Surgery Department, Georges Pompidou European Hospital and Paris Descartes University, Paris, France

Received 4 February 2009; received in revised form 13 May 2009; accepted 14 May 2009.

^_* Corresponding author. Address: Thoracic Surgery Department, Georges Pompidou European Hospital, 20-40 rue Leblanc, 75015 Paris, France. Tel.: +33 1 56093451; fax: +33 1 56093380. (Email: marc.riquet{at}egp.aphp.fr).

Objective: Lung resection for complex aspergilloma (CA) carries high morbidity and mortality and remains controversial in high-risk patients. Cavernostomy followed by muscle-flap plombage has been recommended for patients considered unfit for resection, but subsequent muscle-flap atrophy may be a main cause of failure. We reviewed the place of a limited thoracoplasty in association with that procedure. Methods: Five patients complaining of haemoptysis related to CA were denied lung resection because of bilateral lung destruction (n = 1), and required completion pneumonectomy (previous lobectomy for cancer followed by adjuvant radiation therapy, n = 4). We analysed the data concerning the alternative surgical procedures performed and their immediate and late results. Results: The surgery consisted in cavernostomy, removal of the fungus ball, cavity obliteration with the most directly available muscle flaps (rhomboid muscle n = 2, trapezius and rhomboid n = 2, serratus major and subscapular n = 1). A limited thoracoplasty ranging from 2 to 5 portions of rib (mean resected rib portions n = 3.4) was performed in addition to this procedure. The postoperative course was uneventful. All patients are still alive (mean follow-up 3 years; range: 1–6 years) and faring well without thoracoplasty-related aftereffect, complication related to muscle-flap disuse atrophy nor recurrence of the disease. Conclusion: Cavernostomy followed by muscle transposition has been reported to provide encouraging results. Combining a limited thoracoplasty during the same operation is a simple, safe and well-tolerated procedure regularly achieving good results, and thus deserving consideration.

Key Words: Aspergilloma • Myoplasty • Thoracoplasty • Pneumonectomy • Haemoptysis