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The radiological appearances of diffuse pulmonary shadowing are not specific and frequently histological examination is necessary to provide a diagnosis or assess the activity of the disease. From July 1979 to May 1983 open lung biopsy was performed in 101 patients through a limited submammary incision. Twenty seven patients had undergone prior invasive investigations and 27 were taking corticosteroids at the time of biopsy. In 92 patients the histological appearances after open lung biopsy were sufficiently specific to permit diagnosis. Respiratory tract infection occurred in six patients and in eight there was some superficial infection of the wound. These complications were more frequent in patients taking corticosteroids but the difference was not statistically significant. The chest drain was removed usually on the first postoperative day. In three critically ill patients an air leak occurred after removal of the drain, requiring formal surgical re-exploration and drainage in two cases and a brief period of intercostal drainage in the third. Four patients in the series died. All had severe pre-existing lung disease; in three open lung biopsy was performed in the late stages of severe, rapidly progressive lung disease eluding diagnosis; the fourth patient, who had massive pulmonary fibrosis from asbestos lung disease, developed a respiratory tract infection and died from progressive respiratory failure. Open lung biopsy can be performed with minimal morbidity and a high diagnostic yield. The approach used in this series provides a safe and reliable operation with good cosmetic results. [ABSTRACT FROM AUTHOR]

From 1956 to 1980 85 patients were admitted to the Brompton Hospital, London, with pulmonary aspergilloma. The mean follow-up period was 8.7 years and 85% of patients were followed for five years or until death if this was earlier. There were 41 deaths, 27 from respiratory causes: 11 from pneumonia, six from chronic respiratory failure, seven after surgery for aspergilloma, and three from haemoptysis. Medical treatment alone was given to 36 patients, of whom three died of haemoptysis. Systemic antifungal treatment was given to 18 patients without benefit. Intracavitary antifungals were helpful in three out of 10 patients. Surgical resection was performed in 41 patients, of whom three (7%) died after operation and a further six (15%) developed major complications. Cavernostomy was performed in nine patients considered unfit for resection; four died after operation. Haemoptysis was absent or minor in 40 patients, of whom 19 were treated medically and 18 by resection, with similar five-year survival rates of 65% and 75%. Frank or major haemoptysis occurred in 45 patients, of whom 17 were treated medically and 23 by resection, with five-year survivals of 41% and 84% (p less than 0.02). The better survival of the surgical group in this retrospective survey may have been due to the selection of patients with better lung function and more localised pulmonary disease. Our observations suggest that surgical resection for aspergilloma should be restricted to patients with severe haemoptysis and adequate pulmonary function. In patients unfit for resection cavernostomy is hazardous. [ABSTRACT FROM AUTHOR]