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Aspergilloma of the Lung : Strategy to Prevent Endobronchial Spillage
Preety Mittal Roy, Sangeeta Khanna, Yatin Mehta, Ali Zameer Khan.
Medanta, The Medicity, Gurgaon, India.

Aspergilloma of the Lung : Statergy to Prevent Endobronchial Spillage
Objective - Aspergilloma eroding into the airway may lead to spillage and hence contamination of the normal lung. Our aim in this type of case scenario is to protect the contralateral lung and if possible, uninvolved lobes of ipsilateral lung.
Methods - 57 years male patient was diagnosed with aspergilloma of the right upper lobe and was posted for robotic right upper lobectomy. CT scan of the chest revealed a partially collapsed right upper lobe with suspected aspergilloma formation in extensive fibro-cavitary tubercular lesion. The lesion appeared to communicate with the airway. Patient was placed in trendelenberg, right lateral position before induction to prevent spillage into the healthy left lung and right middle and lower lobes. A standard general anaesthetic was induced and airway was secured with a 37 Fr left double lumen tube (DLT). Isolation of the lung was confirmed with a fibreoptic bronchoscope. To protect the normal lung lobes on the right side a 4 Fr Fogarty catheter was introduced in the right main stem bronchus and positioned in the bronchus intermedius. This was done under direct fibreoptic vision through the tracheal lumen of DLT after clamping the right side. The cuff was inflated with 2 ml of air and an apparent good seal was obtained. Patient was then positioned left lateral for the surgery, which proceeded uneventfully.
Results – In this case bronchial cuff of the double lumen tube is isolating the contralateral left lung and fogarty balloon is isolating the ipsilateral right sided middle and lower lobes.
Conclusions - With this approach we have advanced from side selective to lobe selective protective technique and hence can achieve better lung protection. Moreover, we were able to achieve some degree of lung protection at the time of induction even before airway was secured.

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