2013 Volume 27 Issue 4 Pages 465-471
The patient was a 53-year-old male, who received right ureteronephrectomy for a right renal pelvic carcinoma. Then, he underwent two partial pulmonary resections and left upper segmentectomy for metastatic lung tumors, which recurred loccally twice. He also underwent three systemic chemotherapies with different regimens during treatment. After that, while he attended our hospital as an outpatient, he had a persistent cough and aqueous sputa; furthermore, he was emergently admitted to our hospital due to a high temperature. His symptoms did not improve despite antibiotic treatment, and we performed chest drainage because we considered the possibility of pleural empyema. A culture test of the pleural effusion revealed positivity for Aspergillus flavus; moreover, we deteceted many fungal granules by thoracoscopy, leading to a diagnosis of Aspergillus empyema. The efficacy of the systemic anti-fungal therapy of micafungin and voriconazole was insufficient, and so we combined it with bronchial occlusion using the endobronchial Watanabe spigot®. This led to the successful management of Aspergillus empyema.
