Clinical course and prognostic factors of pulmonary aspergilloma

Background and objectiveThere is limited data on size change during natural progression of pulmonary aspergilloma. We aimed at elucidating the clinical course and prognosis of aspergilloma according to its size change. MethodsA multicentre retrospective observational study was performed in 143 adult pulmonary aspergilloma patients with serial chest computed tomography images. The clinical course and risk of haemoptysis according to the size change of the cavity or mass of aspergillomas was evaluated. ResultsMedian follow-up duration was 5.1 years. The size of aspergillomas changed in 39.2% of study subjects. Decreased and increased volumes of aspergilloma were observed in 13.3% and 25.9%, respectively. Patients with decreased volume had significantly higher C-reactive protein, and more severe bronchiectasis and tuberculosis-destroyed lung. Clinically significant haemoptysis occurred in 50.3% of patients and was significantly associated with the cavity and mass volume of aspergilloma, but not the extent of volume change. A mean cavity diameter of more than 22mm and a mass diameter of more than 18mm increased the risk of clinically significant haemoptysis. ConclusionsA significant portion of pulmonary aspergilloma changed size in our population. The prevalence of clinically significant haemoptysis was associated with absolute size of cavity and mass of aspergilloma. Pulmonary aspergillomas remain stable in the majority of cases, but some of them increase or decrease in size, and the minority of them resolve completely. There is a high prevalence of haemoptysis in pulmonary aspergilloma, associated with absolute size of aspergilloma and mass-containing cavity.