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Objective: In developing countries like India where tuberculosis is highly prevalent, the incidence of pulmonary aspergilloma is also high. Mortality and morbidity associated with surgical treatment of aspergilloma in previous studies has discouraged surgeons from taking up surgery as the preferred treatment. This study focuses on the clinical outcome of patients with pulmonary aspergilloma and its surgical management. Methods: Fifty-one patients who underwent thoracotomy for pulmonary aspergilloma from 2015 to 2017 were studied retrospectively by reviewing their medical records. Results: The most common clinical presentation of pulmonary aspergilloma was hemoptysis, which occurred in 76.0% of patients. Tuberculosis was the most common pre-existing disease (72%). High resolution computed tomography of chest, showed the typical "air-crescent" sign in all patients. Systemic antifungal therapy neither palliated the clinical symptoms nor eradicated the aspergilloma, and transarterial embolisation was also unsuccessful. Surgery offered the only chance of cure for both unilateral and bilateral disease. Procedures varied from segmentectomy to pneumonectomy with most (75%) undergoing lobectomy. There was no death following surgery and postoperative complications occurred in 5 patients. Postoperatively, most of the patients were symptom-free. Conclusion: Symptomatic pulmonary aspergilloma patients are best treated by early surgical intervention with good results in experienced centers. [ABSTRACT FROM AUTHOR]

Background: Post‐tuberculosis lung abnormality (PTLA) is the most common risk factor for developing chronic pulmonary aspergillosis (CPA). However, the prevalence and incidence of CPA in PTLA patients in India remain unknown. Objectives: We aimed to ascertain the incidence and prevalence of CPA in subjects with PTLA. Methods: We identified a cohort of pulmonary tuberculosis who completed anti‐tuberculosis therapy (ATT) before November 2019 from the records of the 12 tuberculosis treatment centers attached to the national program. We recorded the clinical and demographic details. We performed computed tomography (CT) of the chest and estimated serum A. fumigatus‐specific IgG. We categorised subjects as PTLA with or without CPA using a composite of clinical, radiological, and microbiological features. We resurveyed the subjects at 6 months (or earlier) for the presence of new symptoms. We calculated the prevalence and the incidence rate (per 100‐person years) of CPA. Results: We included 117 subjects with PTLA, with a median of 3 years after ATT completion. Eleven subjects had CPA in the initial survey, and one additional case developed CPA during the second survey. The prevalence of CPA in PTLA subjects was 10.3% (12/117). The total observation period was 286.7 person‐years. The median (interquartile range) time to develop CPA after ATT completion was 12.5 (5–36.7) months. We found the CPA incidence rate (95% confidence interval) of 4.2 (1.8–6.5) per 100‐person years. Conclusion: Chronic pulmonary aspergillosis complicates 10% of PTLA subjects after successful outcomes with ATT. Four new CPA cases may develop per 100‐persons years of observation after ATT completion. We suggest screening patients with PTLA who develop new symptoms for CPA. [ABSTRACT FROM AUTHOR]

Abstract: As compared to aspergilloma which is usually developed after complication of tuberculosis in India, endobronchial aspergilloma is a rare disease entity. We report a rare case of endobronchial aspergilloma which is presented radiologically as a solitary pulmonary nodule. A 24-year-old male presented to the Department of Tuberculosis and Chest Diseases with moderate to severe hemoptysis for the last three months. Chest X-ray (PA view) showed ill-defined homogenous shadow in the right upper zone. CECT Thorax review showed intrabronchial mass in the posterior segment of the right upper lobe. CT-guided FNAC was performed, which reveals Aspergillus hyphae mixed with sputum and necrotic material, without any evidence of malignancy. Fibreoptic bronchoscopy was done, it reveals a ball-like region, occluding partially, the lumen of the posterior segment of right upper lobe with hyperemia. The ball was movable. Biopsy was performed and it revealed a partially eroded lining of metaplastic squamous epithelium, overline of chronically inflamed granulation tissue and scar intermingled with fungal hyphae. Serological test for Aspergillus precipitin was positive. The ball was removed using forceps and basket. Endobronchial aspergilloma may be present as solitary pulmonary nodule on chest X-ray. Bronchoscopic and endobronchial biopsies are invaluable in the diagnosis of endobronchial aspergilloma. [ABSTRACT FROM AUTHOR]