Objective: The purpose of this study was to describe the approaches to the diagnosis and the treatment of chronic necrotizing pulmonary aspergillosis (CNPA).
Methods: The study included 8 patients with CNPA confirmed by histopathological studies. The patients were admitted to the First Affiliated Hospital of College of Medicine of Zhejiang University during 2000-2004. The clinical data were analyzed, and related literature was reviewed. The clinical, radiological and pathological characteristics, and the approaches to the diagnosis and the treatment were described.
Results: CNPA was a rare form of pulmonary aspergillosis. Common presentations included productive cough (8/8), haemoptysis (7/8) and constitutional symptoms (5/8). Radiographically, the air crescent sign was suggestive of the diagnosis, which was found in 4 patients. Consolidation was also common in the other 4 cases. The histological feature of CNPA included the presence of tissue invasion by Aspergillus, tissue necrosis and granulomatous inflammation.
Conclusions: The clinical manifestations of CNPA are non-specific. Radiography plays a pivotal role in the diagnosis of CNPA. Treatment with antifungal medications is indicated once the diagnosis is made. Pulmonary resection should be considered when patients have prolonged illness or frequent haemoptysis.