Ct-guided microwave ablation of an aspergilloma

SESSION TITLE: Procedures in Chest Infections Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Aspergillosis is a disease caused by the fungus Aspergillus. Invasive aspergillosis is most commonly seen in immunocompromised individuals. Colonization of lung cavity spaces can lead to formation of an aspergilloma. Aspergillosis can also be seen in patients with underlying pulmonary disease such as asthma, COPD, and cystic fibrosis. Hemoptysis is a common clinical presentation in symptomatic patients. First line treatment of aspergillosis includes anti-fungal triazole therapy. For life threatening symptoms, including hemoptysis, bronchial embolization and/or surgical interventions are indicated in patients with unilateral localized disease. However, in an inoperable patient there are limited definitive treatment options. We present a case of an immunocompetent patient who failed surgical intervention and will undergo CT-guided microwave ablation of an aspergilloma. CASE PRESENTATION: A 62-year-old male with a past medical history significant for tobacco use for 40 years, emphysematous COPD, and type 2 diabetes mellitus who presented with left lower lobe mass/infiltrate on chest x-ray following an episode of hemoptysis. CT scan of the chest was significant for bullous emphysema and a 3 cm ovoid focus within a bulla in the left lower lobe which may represent a mycetoma. Prior chest CT from 4 years ago demonstrated a similar 1 cm lesion. Of note, patient is retired from the military. The patient was evaluated by Infectious Disease and started on Isavuconazole. Infectious Disease also recommended a bronchoscopy with BAL and a PET-CT to rule out malignancy. (1,3) β-d-glucan assay and Aspergillus IgG were found to be positive. There was a low suspicion of malignancy on PET-CT. Aspergillus was detected on BAL culture and acid-fast bacilli was negative. Cardiothoracic surgery was consulted for a therapeutic lobectomy. Surgical intervention of left lower lobectomy was aborted intraoperatively due to a frozen chest cavity formed by extensive adhesions. Due to the inability to proceed with surgery, patient elected to schedule a CT-guided microwave ablation of the left-lower lobe fungal mass. DISCUSSION: The gold standard for symptomatic aspergilloma is surgical intervention with brachial artery embolization if indicated for short-term symptom control. Due to failure of both anti-fungal therapy and surgical intervention, the patient will undergo CT-guided microwave ablation. Prior studies have supported the use of CT guided microwave ablation to be safe and efficacious in the treatment of primary and secondary tumors in the lung and liver. CONCLUSIONS: In conclusion, there are limited non-surgical treatments for symptomatic aspergilloma. In our case, VATS lobectomy was aborted. This case highlights the potential benefit of microwave ablation in the treatment of the fungal ball in an inoperable candidate.This procedure allows for a novel, practice changing alternative to current treatment options. Reference #1: Lang M, Lang AL, Chauhan N, Gill A. Non-surgical treatment options for pulmonary aspergilloma. Respir Med. 2020;164:105903. doi:10.1016/j.rmed.2020.105903 Reference #2: Ko WC, Lee YF, Chen YC, et al. CT-guided percutaneous microwave ablation of pulmonary malignant tumors. J Thorac Dis. 2016;8(Suppl 9):S659-S665. doi:10.21037/jtd.2016.09.44 Reference #3: Betancourt BY, Garofoli AC, Sandhu JS, Boma N, Sy AM. Pulmonary aspergillosis presenting with recurrent haemoptysis. BMJ Case Rep. 2015;2015:bcr2015211249. Published 2015 Jul 7. doi:10.1136/bcr-2015-211249 DISCLOSURES: No relevant relationships by Adam Devine No relevant relationships by Santhosh Gheevarghese John Employee relationship with UPMC Central PA Please note: 1996-Present Added 04/04/2022 by John Goldman, value=Salary No relevant relationships by Jason Maragh No relevant relationships by Troy Moritz No relevant relationships by Vishwant Tatagari