Hemoptysis is common in pulmonary aspergilloma. Current treatment modalities such as surgical resection or bronchial artery embolization (BAE) are limited by lack of technical expertise and risk of recurrence, respectively. We describe our experience of treating aspergilloma and hemoptysis with bronchoscopic instillation of voriconazole.
We retrospectively reviewed records of patients with symptomatic aspergilloma undergoing bronchoscopic voriconazole instillation. Four sessions were carried out at weekly intervals using 400 mg voriconazole dissolved in 20 mL 0.9% normal saline.
A total of 82 subjects were evaluated [66 males; mean (SD) age, 43.2 (14.1) y]. The commonest underlying etiology was posttubercular sequelae (95.1%). Of these, 18 patients (22%) had BAE within the last 1 year. The mean (SD) size of aspergilloma was 4.5 cm (1.5 cm). Following voriconazole instillation, 25 patients (30.5%) had significant resolution of hemoptysis after first session, and 52 patients (68.3%) after the second session. Transient postprocedure cough (n=38; 46.3%) was the commonest procedure-related adverse event. Follow-up CT (n=47) showed reduction in aspergilloma size in 54% and no change in 40.4%. The median (IQR) hemoptysis-free period was 12 months (IQR, 9 to 15.5 mo). Recurrence of significant hemoptysis occurred in 24 (29.3%) patients during a median follow-up of 14.5 months (IQR, 9-18 mo). A history of prior BAE and baseline aspergilloma size were significantly associated with recurrence of significant hemoptysis.
Intrabronchial voriconazole instillation seems to be a safe and effective modality for hemoptysis control in pulmonary aspergilloma.