2Imtiyaz Ahmad Khan, 1Ankur Goyal, 1Ashu Seth Bhalla, 1Raju Sharma, 1Rajender Prashad, 3Abanti Das

1AIIMS New Delhi, New Delhi, India; 2Gmc Srinagar, Srinagar, India; 3Vmmc New Delhi, New Delhi, India

Background:

To compare intraoperative blood loss in patients of pulmonary aspergilloma (PA) undergoing surgery with and without preoperative chest-wall collateral embolization (PCE). To identify imaging parameters on preoperative CT Bronchial Angiography (CTBA) which may aid in judicious patient selection for PCE

Material(s) and Method(s):

Retrospective evaluation of the patients with PA who underwent thoracic surgery from Jan 2013 till Dec 2019 was done and patients divided into three groups: Embolization Group (PCE done before surgery), Non-embolization Group (PCE not deemed necessary) and Control Group (Prior to Jan 2017; PCE not done). For first two groups, CTBA and DSA images were reviewed by two radiologists in consensus on a workstation. In addition to assessing CT findings, we calculated lesion and collateralization score to comprehensively assess imaging morphology of aspergillomas. Kruskal-Wallis, Fischer’s, Wilcoxon rank sum tests and regression analysis were done.

Result(s):

The mean blood loss was lowest in embolization group (644.44ml, 18 patients), followed by non-embolization group (1050ml, 9) and highest in control group (1373.75ml, 40) with significant difference between embolization and control groups (p=0.023). Intraoperative blood loss showed significant correlation with type of aspergilloma (p=0.033), length of pleural interface (rho 0.49, p=0.008), lesion score (rho 0.42, p=0.025) and collateralization score (rho 0.40, p=0.033). For every 1 unit increase in Lesion Score and collateralization score, intraoperative blood loss increased by 137.52 ml and 47.99 ml respectively.

Conclusion(s):

PCE was useful in reducing intra-operative blood loss in patients undergoing surgery for aspergilloma. .Type of aspergilloma, Length of the pleural interface, lesion score and collateralization score corroborated with the blood loss and thus may be used as parameters to judiciously select patients for PCE.