2005 Volume 19 Issue 1 Pages 27-31
A 75-year-old man, who had undergone a decortication for tuberculous empyema a year earlier, was admitted to our hospital with the complaints of appetite loss and cough. A chest radiograph showed an air-fluid level in the left thoracic cavity and chest CT showed a pulmonary aspergilloma in the left apex. Aspergillus was isolated from his pleural effusion. Despite an open-window thoracostomy for empyema thoracis, aspergillus was repeatedly isolated from the sputum, and a cavernostomy, with the removal of the fungus ball, was performed three months later. After another three months of sterilization of both the thoracic cavity and the intrapulmonary cavity through the opened thoracostomy had achieved infection control, the patient successfully underwent a left pneumonectomy with omentoplasty. He has been well with no evidence of recurrence for twelve months. Staged thoracostomy and cavernostomy followed by pneumonectomy appear to have cured this combined pulmonary aspergilloma and aspergillus empyema, although this treatment strategy has not been seen in the literatures.
