Pulmonary Aspergilloma After Tuberculosis Presenting With Recurrent and Life-Threatening Haemoptysis: A Five-Patient Tertiary -Centre Case Series

Abstract

Background: Pulmonary aspergilloma commonly develops in pre-existing cavities after tuberculosis and may cause recurrent or life-threatening haemoptysis. Surgery is the definitive treatment for localized disease, while embolization can control acute bleeding. Methods: We retrospectively reviewed five patients with pulmonary aspergilloma associated with previous or presumed pulmonary tuberculosis who underwent definitive surgical treatment at a tertiary-care centre in South India between March and May 2025. Four patients presented with recurrent haemoptysis and underwent elective lobectomy. One patient with life-threatening haemoptysis underwent pulmonary arterial embolization followed by definitive lobectomy. Results: Histopathology confirmed aspergilloma in all resected specimens. Dense pleural adhesions and distorted tissue planes were encountered in several patients. Postoperative complications included prolonged air leak in one patient and empyema in one patient; both were managed successfully. There was no perioperative mortality or recurrence of haemoptysis during the 6-month follow-up period. Conclusions: Surgical resection provided definitive treatment for localized post-tuberculous aspergilloma with significant haemoptysis. Pulmonary arterial embolization was effective for controlling life-threatening bleeding before definitive surgery. Multidisciplinary coordination between thoracic surgery or interventional radiology is important for managing these complex cases.