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PubMed2002

[Pyothorax in pneumonectomy cavity. Apropos of 24 cases].

AIM OF THE STUDY: Describe as series of post-pneumonectomy empyema episodes, with or without bronchial fistula treated at the department of Thoracic Surgery, University of Ibn Sina, Rabat, Morocco. PATIENTS, METHOD AND RESULTS: Twenty-four patients with post-pneumonectomy pyothorax cared for between 1991 and 2000 were reviewed retrospectively. There were 15 men and 9 women, mean age 34 years. Pneumonectomy was indicated for tuberculous pyothorax and destroyed lung (n = 8), 8 destroyed lung (n = 8), pulmonary aspergilloma (n = 2), pulmonary hydatidosis (n = 2), bronchial dilatation (n = 2), lung cancer (n = 1), and bullet wound (n = 1). The patients were divided into two groups according to presence or absence of bronchial fistula: group 1, 19 patients with without bronchial fistula, and group 2 5 with bronchial fistula. Fourteen patients in group 1 (73.7%) achieved definitive cure, 12 after drainage and washout (63%) at mean delay of 45 days and 2 after drainage and washout with thoracoplasty. Five patients did not respond to hospital drainage and washout and remained under definitive ambulatory drainage as they declined further surgical treatment. One death occurred in this group. Two patients in group 2 (40%) achieved definitive cure, one after daily aspiration, and the other after thoracoplasty. Two fistulae in one patient were treated with nitratage. For this patient, we also attempted revision of the bronchial stube via posterior throacotomy, the closure of the bronchial fistula using an intercostal muscle flap associated with thoracoplasty. All these methods failed. There were two deaths in this group. CONCLUSION: Sixteen patients were definitively cured (66.6%). Eight patients (33.3%) remain in a chronic condition. Patients with pyothorax on a pneumonectomy cavity should be managed in specialized centers before reaching the chronic stage. Thoracomyoplasty with preparation of the cavity by thoracostomy should be proposed.

Adolescent↗
PubMed2005

[Evaluation of open window thoracostomy for chronic tuberculous empyema with broncho-pleural fistula; a retrospective analysis of 33 cases].

We report here our 13-year experience treating chronic tuberculous empyema by open window thoracostomy. The subjects were 33 patients (28 males and 5 females) with a median age of 70 (range: 56-83) years who underwent surgery between January 1990 and December 2002. Patients with a history of pulmonary resection or thoracoplasty were excluded. All patients complained of cough and purulent sputum related to the presence of bronchopleural fistula. Previous illnesses included pulmonary tuberculosis (n = 20) and tuberculous pleurisy (n = 14) treated by artificial pneumothorax (n = 1) or chemotherapy (n = 22). Median duration from the initial episode of tuberculosis to surgery was 44 (range: 1-60) years. Mycobacterium tuberculosis (n = 9), Aspergillus fumigatus (n = 6), methicillin-resistant Staphylococcus aureus (MRSA) [n = 5], and Pseudomonas aeruginosa (n = 5) were representative microorganisms isolated from empyema. Preoperative mean %VC was 48 (range: 31-74)%. Mean follow-up was 34 (range: 1-131) months. Seven patients died of empyema-related disease within 6 months postoperatively. Nine patients underwent curative surgery to close the thoracostomy, including extrapleural pneumonectomy (n = 5), muscular transposition with thoracoplasty (n = 3), and lobectomy with muscular transposition and thoracoplasty (n = 1). In 17 patients, the thoracostomy was left open throughout the observation period because of severe impairment of pulmonary function. In elderly patients with severely impairment of pulmonary function, open window thoracostomy does not control empyema well and has a high rate of mortality.

Aged↗
PubMed2006

[Surgical treatment of pulmonary aspergilloma. 278 cases].

STUDY OBJECTIVES: The purpose of this study was to report the results of surgical treatment of pulmonary aspergilloma in 278 consecutive patients in a hospital using surgical treatment systematically when possible to avoid potentially fatal bleeding. METHODS: Diagnosis required morphological assessment as well as testing of sputum and blood samples. Preoperative studies also included pulmonary function tests for all patients. Surgical intervention was systematic, for treatment or diagnostic purposes. The incision of choice was a standard posterolateral thoracotomy via the 5th intercostal space. Mycological examination of the parenchymatous cavity confirmed the diagnosis. Immediate postoperative surveillance depended on clinical, radiologic, and laboratory findings as well as pleural drainage. Postoperative clinical and radiographic follow-up took place during the first month, the third month and then every 6 months. RESULTS: Between 1982 and 2004, our thoracic surgery department saw 320 cases of pulmonary aspergilloma. In all, 278 patients (161 men and 117 women) underwent pulmonary resection. The mean age was 32 years (range: 16-70 years). The principal underlying disease was tuberculosis (73%), and the most common symptom hemoptysis (83%). Treatment was exclusively surgical in all patients, and there were 279 resections because one patient had staged bilateral segmentectomy. Resections included 130 lobectomies, 51 segmentectomies, 45 pneumonectomies, 33 lobectomies with segmentectomy, 17 bilobectomies and 3 thoracoplasties. There were 16 postoperative deaths (5.7%), 14 of them in patients who had undergone pneumonectomy. Postoperative complications included empyema (12.5%), incomplete reexpansion (9.3%), postoperative bleeding (5%), respiratory infections (4.6%), respiratory failure (4%), bronchial fistula (2.5%) and wound infections (2%). 12 patients had further surgery: 3 for hemothorax, 2 for empyema and 4 for secondary thoracoplasty. The postoperative course was uneventful for 54.1% of cases. CONCLUSION: Surgery for pulmonary aspergilloma is difficult and dangerous. It nonetheless remains the treatment of choice of this opportunistic pulmonary mycosis, despite the high risk of postoperative morbidity and mortality.

Adolescent↗
PubMed2004

[Thoracic aspergillosis: indications for surgery for a multifaceted disease!].

We reviewed the different clinical forms of thoracic aspergillosis and detailed surgical options. Classical aspergiloma where a tuft of Aspergillus grows in a parenchymal cavity is the most well-known entity. Simple forms (little clinical expression, thin-walled cavity without impact on neighboring tIssue) can be distinguished from complex forms (poor general status, thickened cavity, sequellae). Surgery is the last resort for complex forms, but the procedure is benign for simple forms allowing interruption of the spontaneous evolution. Pleural aspergillosis is a common complication of the excision procedure, whether performed early or at mid-term. Thoracoplasty is often required due to the Volume of parenchyma removed. Surgery can be proposed for acute invasive aspergillosis in two situations: to prevent cataclysmic hemoptysis due to a paravascular lesion, or for resection of sequestered mycotic deposits which could lead to generalized reinfection. Semi-invasive aspergillosis is usually observed in areas of post-radiation fibrosis where the typical aspergillar excavation appears after the initial phase of invasion leading to lobular pneumonia. Thoracoplasty is often the only surgical option. Ulcerated aspergillar tracheobronchitis is observed after (heart)-lung transplantation and raises the risk of characteristic invasive aspergillosis. Finally rare observations of parietal aspergillosis have been treated by surgical resection in combination with systemic antifungal agents. Multidisciplinary consultation is required to establish the most appropriate approach.

Aspergillosis↗
PubMed2005

Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: minimum 5-year follow-up.

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the long-term proximal junctional change in adolescent idiopathic scoliosis (AIS) following segmental posterior spinal instrumentation and fusion 5 years or more after surgery. SUMMARY OF BACKGROUND DATA: No study has concentrated on time-dependent long-term proximal junctional change in AIS following segmental posterior spinal instrumentation and fusion after 5 years postoperation. Risk factors for developing proximal junctional kyphosis (PJK) are unknown. METHODS: A total of 193 consecutive AIS patients with a minimum 5-year follow-up (average, 7.3 years; range, 5-16.7 years) treated with segmental posterior spinal instrumentation and fusion were evaluated. Radiographic measurements analyzed included sagittal Cobb angle at the proximal junction on preoperative, early postoperation, 2-year postoperation, and final follow-up (> or = 5 years) by standing long cassette radiographs. Postoperative Scoliosis Research Society (SRS)-24 outcome scores were also evaluated. Abnormal PJK was defined as the final proximal junctional sagittal Cobb angle between the lower endplate of the uppermost instrumented vertebra and the upper endplate of two vertebrae supra-adjacent, which was > 10 degrees and at least 10 degrees greater than the preoperative measurement. RESULTS: The incidence of PJK at 7.3 years postoperation was 26% (50 of 193 patients). The average proximal junctional angle increased 15.2 degrees until 2 years postoperation and then increased 1.7 degrees until final follow-up in the PJK group (n = 50). Factors that were statistically significant for PJK development were as follows: a thoracoplasty procedure (P = 0.001), preoperative hyperkyphotic thoracic alignment (T5-T12 > 40 degrees) (P = 0.015), and hybrid instrumentation (proximal hooks and distal pedicle screws) compared with the hooks only group (P = 0.029). The number of fused vertebrae more than 11 was also related with PJK (P = 0.08). The level of the uppermost instrumented vertebra did not affect the PJK incidence. SRS-24 outcome scores did not demonstrate any significant differences (P = 0.54 for total score and P = 0.49 for self-image subscale) between the PJK and non-PJK groups. CONCLUSION: The incidence of proximal junctional kyphosis at 7.3 years postoperation was 26% and did not progress significantly after 2 years postoperation. Risk factors for developing PJK were an associated thoracoplasty, hybrid instrumentation (proximal hooks and distal pedicle screws), and a preoperative larger sagittal thoracic Cobb angle (T5-T12 > 40 degrees). The SRS-24 outcome instrument was not affected by PJK.

Adolescent↗
PubMed1977

Evaluation of surgical treatments for the major lesion of bilateral silicotuberculosis.

The present communication deals with the follow-up study of 24 patients with bilateral silicotuberculosis in whom only unilateral operation was carried out for major lesions. The operative procedure consisted of pulmonary resection, thoracoplasty or combined operation such as cavernostomy, intracavitary filling of a pedunculated muscle flap and thoracoplasty. The follow-up period ranged 1 year to 12 years and 5 months. The results of surgical treatment for unilateral major lesions and their effect on the contralateral minor lesions were clinically assessed by alterations in the chest x-ray findings and tubercle bacilli in sputum. In 16 of 24 patients (67%) alleviation was obtained, whereas no change occurred in 3 (13%) and aggravation in 5 (21%). The surgical treatment for unilateral major lesion brought about 41% of improvement in the contralateral minor lesions. Contralateral minor lesions remained unchanged in 46% of patients and aggravated in 14%. This shows a value of the surgical threatment for bilateral silicotuberculosis. It should be emphasized that surgical treatments more aggressive than have been heretofore practiced can be employed.

Adult↗
PubMed1996

[The use of the pleural tent in superior lobectomies].

Persistent pleural space must be considered a possible complication after lung resection surgical treatment. Although in most cases the evolution is favourable, the authors suggest the use of the "pleural tent" technique, that compared to others thoracoplasty procedures offers some advantages. A short historical review of the thoracoplasty techniques is presented together with a detailed description of the above-mentioned technique.

Humans↗
PubMed2004

[Intrathoracic omentoplasty in the treatment of pleural cavity secondary to stabilized bronchial fistula].

AIM: The aim of this paper was to verify the effectiveness of omentoplasty, either single or associated to other procedures, in the treatment of permanent fistula of the main bronchi. METHODS: The authors report their experience of 10 intrathoracic omentoplasties for pleural cavity from fistula of the main bronchus. In 2 cases a single omentoplasty was performed, while 8 patients had an associated procedure (4 thoracoplasties, 7 mioplasties and 2 mammoplasties). In 8 cases the vascular pedicle used for the omentum was the right gastroepiploic artery, and the left one in the remaining 2 patients. The omentum was mobilized through an opening in the diaphragm and anchored to the bronchial stump. In the combined plasties it was then covered by chest wall (thoracoplasty), muscles (mioplasty) or mammary gland (mammoplasty); in the single omentoplasty omentum was also sutured to the chest wall. Indication for combined procedures was high bacterial contamination of the pleural cavity; single omentoplasty was performed for small cavities, where other procedures had previously failed. Only in the single omentoplasties a pre-operative selective angiography of the gastroepiploic arteries was performed. RESULTS: Such procedures were resolutive in 9 patients; 1 needed an endoscopic application of fibrin glue. CONCLUSION: Intrathoracic omentoplasty is an effective procedure to solve both pleural cavity and stabilized bronchial fistula, mostly because of plastic and immunologic features of the omentum.

Bronchial Fistula↗
PubMed2004

[Surgical treatment of chronic pleural empyema--seven years' experience].

During a 7 years period a total of 112 patients with chronic pleural empyema were operated on. There were 92 male and 20 female with mean age of 48.4 years. The mean duration of empyema clinical manifestation up to the operation was 59 days. Pleurectomy and decortication were carried out in 99 patients and in the other 5 cases they were associated with pulmonary resection. Additional thoracoplasty was necessary in only 7 patients. Rethoracotomy for hemostasis was performed in 5 (5.6%) patients. The overall postoperative mortality was 5.6%. The mean hospital stay after pleurectomy and decortication was 13 days and after the thoracoplasty it was 19 days. The follow-up period was 6 months for 84 (75%) and 12 months for 70 (62%) of the patients. No disease relapse was observed. Pulmonary function was improved after 3 to 6 months in the majority (89%) of the patients. Fully recovered working capacity was found in 44% of the patients.

Adult↗
PubMed1994

[Indications for surgery and methods of surgical correction of infundibuliform abnormality of the chest in children].

Based on the survey of 104 patients, a method has been developed for early diagnosis of progression of infundibuliform chest deformity (ICD), which defines indications for thoracoplasty in children over 2 years. A differential approach has been applied to the stabilization of the sternocostal complex, taking into account various ICD types. Experience in surgical management of 247 patients with simple and complex ICD types has been generalized. A procedure has been improved to stabilize the sternocostal complex with a metallic plate in critical ICD types. The sparing thoracoplasty variants have been developed for simple ICD types and Degree I progressive ICD ones, stabilizing the sternocostal complex with a niticolic brace and a CPK-22 apparatus in the modified resistant case.

Adolescent↗
PubMed1997

[Surgical treatment for pulmonary aspergillosis].

Between 1985 and 1994, 141 patients with pulmonary aspergilloma underwent surgical treatment in 18 hospitals, which belong to Japanese Tuberculosis Research Committee. Applied surgical procedures are divided into two major categories. One is pulmonary resection variety, and the other is lung preserving or space reducing surgery. The former consists of 20 pneumonectomies, 62 lobectomies and 13 lesser operations. The latter is composed of combined mordalities of space reducing surgery (SRS) such as thoracoplasty, air-plombage, cavernoplasty and muscle plombage to reduce the cavity or the emphysematous bulla, which contains fungus balls within it. This kind of operation is applied for the patients, who have impaired lung function, strong pleural adhesion and severe complications. Triad of thoracoplasty, cavernoplasty and muscle plombage is the most frequent combination and was applied to 20 patients in this study. Operative mortality is one in pulmonary resection group and none in SRS group. Hospital deaths are two in the former and one in the latter. Success rate of operation is 95.8% in pulmonary resection, and 78.3% in SRS, especially 85.0% in the triad, mentioned above. However, SRS required a couple of additional operation on occasion to reach final success. Morbidity rate is 23.2% in pulmonary resection, and 17.4% in SRS. Thoracic empyema with or without bronchial fistula is the most common complication of the former. On the other hand, infection of the residual cavity and subcutaneus abcess are the main complications of the latter.

Adult↗
PubMed1994

[Cavernoplasty for atypical mycobacteriosis of the lung--case report of two M. avium complex].

Two patients were diagnosed as suffering from localized atypical myocobacteriosis of the lung consisting of the infection in tuberculous open healing cavity of left upper lobe and giant bulla of right middle lobe. The type of bacteria classified according to Runyon's criteria was Group 3 (M. avium complex). The bacilli had the resistance to most antituberculotics. One of them had the history of pulmonary tuberculosis complicated with giant cavity in left upper lobe and extensive hard pleural adhesion associated with restrictive ventilatory impairment. Another one had the history or right upper lobe lobectomy for tuberculosis complicated extensive pleural adhesion. A combination of thoracoplasty and cavernoplasty was applied to these two cases whose operation were once to the former and twice to the latter respectively, with satisfactory results. The patients show complete closure of the cavity and bulla and have no symptoms of recurrence after surgery. The application of thoracoplasty and cavernoplasty is useful and safe to the treatment of patients suffering from atypical mycobacteriosis of the lung in cases of prospected tough resection, with expecting one stage cure.

Aged↗
PubMedDate not supplied

Analysis of status of surgery in thoracic tuberculosis.

A retrospective analysis of the surgical procedure in 1655 patients in twenty years in a university hospital for thoracic tuberculosis revealed that the varieties of procedures were necessary in 2.2% cases only. They can be grouped as tubercular empyema with or without bronchopleural fistula in 1507 (91%), complicated pulmonary tuberculosis in 78 (4.7%), cold abscess in the chest wall with or without lymphadenitis in 54 (3.2%) and osteomyelitis of the ribs and sternum in 16 cases (0.9%). This is statistically significant with a confidence interval of 0.1248 to 0.2348. In tubercular empyema 222 procedures were performed of which 162 were minor procedures, intercostal drainage with irrigation: 89 cases, thoracostoma: 56 cases and continuous chest wall tube 17 cases and 60 were major procedures (decortication in 45 cases, thoracoplasty [modified] in 14 cases and muscle transfer in one case). All the above procedures were preceded by an intercostal drainage. In complicated pulmonary tuberculosis the operative procedures were as follows: lobectomy in 33 cases, pneumonectomy in 35 cases and thoracoplasty in 10 cases. Drainage of cold abscess with or without lymphnode resection was performed in 54 cases and in 16 cases of osteomyelitis of the ribs and sternum resection were necessary. All procedures were performed under the cover of antitubercular therapy and supportive treatment with the aim of resolution of process, obliteration of the empyema space, control of sepsis and improvement of activity performance. The morbidity was extensive and mortality was high in major procedures. Good results could be obtained in over 92% cases, and only 66.2% on major surgery cases.

Humans↗
PubMed2001

Intrathoracic transposition of a pectoralis major and pectoralis minor muscle flap for empyema in patients previously subjected to posterolateral thoracotomy.

The latissimus dorsi muscle flap cannot be used to eliminate an empyema cavity in patients who have previously undergone posterolateral thoracotomy, because of the division of this muscle. Moreover, thoracoplasty alone cannot sufficiently eliminate an empyema cavity that includes the thoracic apex, where space remains between the clavicle and the first rib. Therefore, we constructed a flap from the pectoralis major (P.Ma) and pectoralis minor (P.Mi) muscles to eliminate empyema cavities in five patients who had undergone lobectomy (n = 3) or pneumonectomy (n = 2) via posterolateral thoracotomy from 3 months to 40 years previously. All five patients had bronchopleural fistulae, and because of the previous upper lobectomy or pneumonectomy, they had large empyema cavities including the thoracic apex. Open-drainage thoracotomy was performed due to severe infection, and intrathoracic transposition of the P.Ma and P.Mi muscle flap with simultaneous thoracoplasty was carried out 7-124 weeks (mean 38 weeks) later. The P.Ma and P.Mi muscle flap easily reached the apex space with sufficient obliteration of the empyema cavity. All of the patients remained free of empyema 12-85 months after thoracic closure. The P.Ma and P.Mi muscle flap is useful for eliminating empyema cavities including the thoracic apex in patients who have previously undergone a posterolateral thoracotomy.

Aged↗
PubMed2004

Transposition of modified latissimus dorsi musculocutaneous flap in the treatment of persistent bronchopleural fistula after posterolateral incision.

The condition of a 51-year-old man was complicated with empyema and bronchopleural fistula (BPF) after left upper lobectomy and thoracoplasty for pulmonary aspergillosis. On the postoperative day (POD) 12, the opened bronchial stump was directly closed and covered with a pedicled pectoralis major muscle flap. On POD 66, an open-window thoracostomy was done, because of empyema with Pseudomonas aeruginosa Two years later, we could fill the empyema cavity, and close the multiple BPFs with the transposition of a modified pedicled musculocutaneous (MC) flap and the additional thoracoplasty to gain good quality of life. Although the MC flap was a proximal part of the latissimus dorsi muscle, which was dissected along the posterolateral incision of the first operation, it could be successfully transplanted to cover the BPFs in the open-window. In some patients with a small open-window on the upper anterior chest wall, the pedicled proximal latissimus dorsi MC flap may be very useful for treating persistent BPFs even after a standard posterolateral incision.

Bronchial Fistula↗
PubMed1994

The pectoral muscle flaps in the treatment of bronchial stump fistula following pneumonectomy.

Between 1975 and June 1992, pneumonectomy was performed in 594 patients, of whom 33 (5.6%) developed bronchopleural fistulae postoperatively. Until 1989 25 cases were reoperated: 5 patients were treated by thoracoplasty primarily, 20 by repair of the stump with sutures and by covering the stump with pericardial tissue or intercostal muscle, of whom 10 suffered from empyema. In 5/20 patients (25%) chronic fistulae developed making further interventions necessary. Since 1989 seven patients with bronchial stump fistulae have been reoperated with a delay of less than 12 h after diagnosis. Surgery consisted of reclosure of the stump with sutures in five patients. In addition, every patient was treated with the intrathoracic transposition of a petiolated ipsilateral pectoral muscle graft, which was the only treatment in two patients. Neither recurrence of the bronchopleural fistula nor empyema was seen in this group of patients (0%). We conclude that bronchial stump fistulae in patients after pneumonectomy can be treated successfully by the use of pectoral muscle flaps either combined with a closure of the leak using sutures or as the only measure. The method proved to be simple, safe and without major impairment of the patient. In combination with early reintervention, postpneumonectomy empyema including a disfiguring thoracoplasty can thereby often be avoided.

Bronchial Fistula↗
PubMed2005

Surgical results for chronic empyema using omental pedicled flap: long-term follow-up study.

BACKGROUND: Successful treatment of chronic empyema remains a challenge for thoracic surgeons. Herein, we report our 17 years of experience with the omental pedicled flap procedure for management of chronic empyema secondary to pulmonary tuberculosis. METHODS: We retrospectively reviewed the surgical results of 23 patients who underwent surgical treatment for chronic empyema using an omental pedicled flap from 1987 to 2003. RESULTS: The subjects were 20 men and 3 women (mean age, 58.1 years) with average % vital capacity (VC) and forced expiratory volume in 1 second (FEV1) values of 48.1% and 1.19 L, respectively. Sixteen patients (69.6%) had bronchopleural fistulas and 21 (91.3%) were associated with infection by causative organisms (6 Aspergillus organisms, 4 methicillin-resistant Staphylococcus aureus, 10 others). An open window thoracostomy preceded in 17 patients (72.9%). Eleven patients were treated using an omental pedicled flap with or without a muscle flap, and 12 were treated using an omental pedicled flap with a partial thoracoplasty. There was 1 operation-related death, and clinical success was achieved in 19 patients (82.6%), in whom pulmonary function did not decrease significantly. During long-term follow-up, 5 patients died of respiratory failure, and their mean postoperative %VC and FEV1 values were 30.1% and 0.76 L, respectively. CONCLUSIONS: We concluded that the use of an omental pedicled flap for chronic empyema was effective even in cases with active infection, and did not compromise pulmonary function. Further, an additional thoracoplasty may completely obliterate the dead space, although indications should be referenced to preoperative pulmonary function.

Aged↗
PubMed2005

[Role of surgery in the treatment of pulmonary aspergillosis].

INTRODUCTION: This article reviews the different forms of pulmonary disease caused by aspergillus and discusses the possible surgical treatments. The most well known is the classic aspergilloma which develops as a fungal ball in the centre of a pre-existing pulmonary cavity. STATE OF KNOWLEDGE: One can distinguish simple (few symptoms, thin walled cavity without immediate complications) and complex forms (patient generally unwell, thick cavity, complications). In the complex form, surgical intervention must be considered as a last resort. In the simple form, surgery is relatively benign and prevents disease progression. Pleural aspergillosis can occur, usually following the surgical removal of a cavity either in the short or medium term. Given the loss of lung parenchyma thoracoplasty is often the only option. OUTLINES: Two different scenarios occur in acute invasive aspergillosis where surgery may be indicated: firstly, surgery can be considered in the event of haemoptysis related to vascular erosion; secondly, resection of mycotic sequestrations before intensification or resumption of therapy may prevent a relapse. Semi-invasive aspergillosis usually occurs in territories of post-radiation fibrosis: after a phase of invasion equivalent to a lobar pneumonia, a secondary cavity appears containing a small fungal ball. Thoracoplasty is often the only surgical option. Ulcerating tracheobronchial aspergillosis has been observed following (cardio-) pulmonary transplant and this may progress to a characteristic invasive aspergillosis. CONCLUSIONS: Finally, rare observations of parietal aspergillosis could be treated by surgical resection and associated with systemic antifungal therapy. Optimum management of these patients requires a multidisciplinary approach.

Acute Disease↗