Bronchomediastinal fistula caused by endobronchial aspergilloma.

Published

Journal Article

RATIONALE: Endobronchial aspergilloma is a rare condition affecting immunocompromised patients. We present three cases resulting in airway fistulae. CASE PRESENTATIONS: A 68-year-old male with orthotopic heart transplantation presented with fatigue, cough, and dyspnea. A computerized tomography (CT) scan of the chest and bronchoscopy revealed an endobronchial right mainstem mass and airway fistula to the mediastinum. The mass was debrided and biopsy showed Aspergillus fumigatus. He was treated with antifungals and recovered. A 52-year-old male with acquired immunodeficiency syndrome presented with cough, dyspnea, and hypoxemia. Chest CT showed a bronchus intermedius mass and fistula to the mediastinum. Bronchoscopy revealed a necrotic endobronchial mass and pseudomembranes and confirmed the presence of a fistula. The mass was resected bronchoscopically and Aspergillus fumigatus was isolated. He was treated with antifungals and the fistula healed. A 63-year-old male with chronic lymphoid leukemia was admitted for dyspnea, cough, weakness, and dysphagia. Chest CT and bronchoscopy showed a mass causing obstruction of the subglottic trachea and a fistula to the mediastinum. Biopsy showed Aspergillus fumigatus and he was treated with antifungals. The sinus healed but the patient died of leukemia. MAIN RESULTS: Risk factors for airway aspergilloma include immune deficiency, mucosal damage, and ischemia. We report airway fistula formation as a complication of this infection, which has not been previously emphasized. CONCLUSIONS: Endobronchial aspergillomas may form fistulae to the mediastinum. Aggressive treatment with antifungals and bronchoscopic interventions are required.

Full Text

Duke Authors

Cited Authors

  • Argento, AC; Wolfe, CR; Wahidi, MM; Shofer, SL; Mahmood, K

Published Date

  • January 2015

Published In

Volume / Issue

  • 12 / 1

Start / End Page

  • 91 - 95

PubMed ID

  • 25513736

Pubmed Central ID

  • 25513736

Electronic International Standard Serial Number (EISSN)

  • 2325-6621

Digital Object Identifier (DOI)

  • 10.1513/AnnalsATS.201406-247BC

Language

  • eng

Conference Location

  • United States