Aspergilloma

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Classification according to ICD-10
B44 Aspergillosis
B44.0 Invasive aspergillosis of the lungs
B44.2 Aspergillosis of the tonsils
B44.8 Other forms of aspergillosis
ICD-10 online (WHO version 2019)

An aspergilloma ( syn. Aspergillus mycetoma) is the colonized form of aspergillosis ( mold infection) that can occur in various locations.

to form

Aspergilloma of the paranasal sinuses with evidence of densely packed fungal hyphae.
Hematoxylin-eosin stain . Magnification 200x

Aspergilloma of the paranasal sinuses

Typically only one side is affected. The aspergilloma grows non-invasively in the sinuses . It can go undetected for a long time, initial discomfort can be purulent secretion , nosebleeds or a feeling of pressure on the affected side. In the X-ray image , the aspergilloma shows up as a shadowing of the respective paranasal sinuses.

Zinc oxide has proven to promote growth . Since the tips of the roots of the teeth in the upper jaw have a close positional relationship to the maxillary sinus , root filling material, which contains zinc oxide-eugenol, can get into the paranasal sinus as part of an endodontic treatment.

The therapy involves surgical removal of the aspergilloma while protecting the mucous membrane of the maxillary sinus. This is done endoscopically through the nose if possible . The aspergilloma appears as a greenish-black stone, which consists of necrotic fungal masses and metabolized calcium . Long-term consequences are not to be expected.

Aspergilloma of the lungs

Pathological preparation of an aspergilloma as a result of tuberculosis.
Detail of an aspergilloma as a complication of sarcoid

An aspergilloma can also form in the lungs in existing (preformed) cavities, such as infected pulmonary emphysema bladders or in scar tissue following inflammation (e.g. tuberculosis ). It has a typical X-ray finding, whereby the round aspergilloma moves in the cavity depending on the position of the body. This finding is used to secure the diagnosis.

Furthermore, laboratory values ​​in the blood are increased (total IgE , radio-allergo-sorbent test (RAST for aspergillus, type I and III serology)). Sometimes the aspergillus can be obtained from the bronchial system by means of bronchoscopy . Complications are the continued infection of the cavity with bacteria and especially the life-threatening bleeding from the cavity wall via the bronchi into the whole lungs. The patient suffers from coughing up blood. This is the point in time for the surgical removal of the lung lobe in which the cavity with the aspergilloma is located. Then the patient is cured. A more recent method is intensive intravenous therapy with one of the newer and more expensive antifungal agents (antifungal agents ), especially if no bleeding has occurred or the patient is not fit for surgery.

literature

Individual evidence

  1. Norbert Schwenzer, Michael Ehrenfeld: Tooth-mouth-jaw medicine. Volume 1: General Surgery. Thieme, Stuttgart 2000, ISBN 3-13-593403-9 . (Full text)

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