PMC10203767_01
(A) Chest radiography revealed pneumohydrothorax in the left thoracic space. (B) Thoracoscopic view of the infected left pleural space. Aspergillus fumigatus was cultured from the resected pleura.C,D) The microscopy image of the excised specimen showed that the lesion was confined to the visceral pleura and consisted of necrotic nests and inflammatory cell nests, and the organisms of Aspergillus were located within the visceral pleura, whereas not in the lung parenchyma (hematoxylin and eosin stain, 20x (C) and 400x (D) magnification).
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He presented to his home physician with persistent complaints of respiratory distress and high-grade fever for one month after the onset of left chest pain and dyspnea, and was found to have a pneumohydrothorax on chest radiography (Fig. 1A). For the failure of conservative treatment, he underwent thoracoscopic decortication at a local hospital (Fig. 1B). A pathological finding of Aspergillus organisms in the pleura (Fig. 1C and D), and a serological positiveness of Aspergillus antibodies led to the diagnosis of spontaneous pneumothorax and Aspergillus empyema.
One month after the decortication, re-infection with Aspergillus occurred and persistent air leak developed. Chest computed tomography revealed parietal pleural thickening in the apical thoracic cavity.
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Chest computed tomography (CT) revealed a large apical pleural space in the left without a fungus ball, and an irregularly thickened pleura in the upper thoracic cavity, suggesting the infection of the pleura and air space (Fig. 2).
Cavernostomy of the apical Aspergillus cavity was performed via the intercostal space between the 2nd rib and the 3rd rib with extraperiosteal air-plombage.
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A 12-cm anterolateral incision was made in the third intercostal space, and cavernostomy was performed on the Aspergillus cavity, providing a clear view from apex to bottom (Fig. 3).
Chest radiography one year after the operation showed full reexpansion of the left lung.
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The patient had good lung reexpansion, with full extension into the bony thorax (Fig. 4).