Bronchial stump aspergillosis

Occasional instances of recurrent or persistent cough or haemoptysis following pneumonectomy for malignancy have been ascribed to Aspergillus infection of the bronchial stump (Sawasaki et al, 1969; Parry et al, 1982; Roig et al, 1993; Noppen et al, 1995). This may occur up to 7 years after sugery and be associated with other manifestations of Aspergillus disease such as aspergilloma or empyema and /or brochopleural fistula. In these instances, silk sutures were used and Aspergillus was able to grow on and around the suture. Removal of the suture is often curative alone. However follow on therapy with itraconazole seems wise as suggested by Noppen et al (1995).