Dong had a history of pulmonary tuberculosis for eight years. Recently, he experienced significant hemoptysis (about 100-200 ml per episode), shortness of breath, chest pain, fatigue, and severe debilitation. A CT scan at Tam Anh General Hospital, TP HCM, revealed he had a pulmonary fungal ball (aspergilloma), a sequela of his previous tuberculosis. The fungus had completely invaded and destroyed his left lung, forming a cavity filled with pus. The damaged lung tissue had also become firmly attached to vital organs such as the heart, aortic arch, and chest wall.

"The fungus had eaten into the pulmonary blood vessels like clinging moss, causing incessant bleeding," Associate Professor, Doctor Vu Huu Vinh, Director of the Thoracic and Vascular Surgery Center, said. Dong had undergone embolization (a technique to seal ruptured blood vessels from within) multiple times, but the bleeding persisted, spilling into his trachea, leading to hemoptysis and spreading to his healthy lung, causing respiratory failure. After a consultation, doctors decided to perform surgery on Dong. Before surgery, the patient received continuous protein infusions and blood transfusions to improve his physical condition, combined with regular respiratory examinations.

The team meticulously dissected layers of skin, chest wall muscles, bone, and pleura to access the lesion and minimize blood loss for the already severely anemic patient. Subsequently, the team removed the entire fibrotic left lung, flushed out the pus, achieved hemostasis, and closed the chest. The fungus had also perforated the diaphragm, requiring doctors to repair it for the patient.

Associate Professor Vinh (right) performs surgery to remove a lung completely perforated by fungus. Photo: Tam Anh General Hospital.

According to Associate Professor Vinh, the biggest challenge after surgery was maintaining stability in the chest cavity. The sudden change in pressure after losing one lung could displace the heart and mediastinum, twisting blood vessels and causing immediate death. To address the void after lung removal, the team injected about two liters of solution to replace the lost lung volume, preventing displacement of the mediastinum and heart. This fluid was replaced daily to prevent infection and flush out residual pus.

"We adjusted the fluid volume centimeter by centimeter daily to allow the patient's body to gradually adapt," Associate Professor Vinh stated, adding that once the chest wall stabilized and internal organs adapted to the new state, the drainage system would be removed.

After 10 days of intensive care, Dong's health gradually stabilized, his lung fluid cleared, the remaining drainage tube was removed, and he was discharged.

Pulmonary fungal disease often develops in patients with a history of tuberculosis, a condition caused by the bacterium *Mycobacterium tuberculosis*. To prevent tuberculosis and pulmonary fungal balls, doctors recommend a healthy lifestyle: no smoking, limited alcohol consumption, keeping homes well-ventilated, and wearing masks in crowded or polluted areas. Patients with a history of tuberculosis, bronchiectasis, or weakened immune systems should undergo regular general health check-ups and lung screenings for early detection and treatment.

Bao Anh

*Patient's name has been changed