Background: Pulmonary aspergilloma is a chronic fungal infection and, without therapy, is often fatal. Death can occur from massive hemoptysis, cachexia, or secondary infection. Standard therapy is surgical resection, but unfortunately, many patients are not candidates due to poor lung function and comorbidities.
 
Objectives:Aspergilloma removal via bronchoscopy may be an important, less invasive, and viable alternative therapy to the gold standard of surgical resection. Important considerations include patient selection, the use of antifungal treatment peri-procedure, optimization of procedure time, and the minimization of the risk of bleeding. We assessed whether this multi-modal approach to therapy may lead to overall benefits and reduced risk of recurrence. 

Methods: We describe a single-centre case series of 15 patients deemed non-surgical candidates selected for endoscopic procedure. All patients received a minimum of 3 months of appropriate antifungal therapy with no improvement in the size of the aspergilloma by radiographic measurements. The procedure was performed by an interventional pulmonologist. Blunt instruments were used to remove the fungus ball. Antifungal treatment was given for 1 to 3 months afterwards.

Results: Across all patients (n=15), subjective symptomatic improvements occurred with no complications observed, including death or bleeding. Follow up time ranged from 6 months to 10 years. Only one patient severely immunocompromised post lung transplant had recurrence of the disease at 3 years.
 
Conclusion: While further study is required to determine the optimal protocol, our proposed multi-modal approach to aspergilloma removal was viable, safe and effective.