Radiotherapy for massive haemoptysis from an aspergilloma.

Recurrent haemoptysis is common in patients with an aspergilloma and occasionally is large enough to be life-threatening or even fatal.' We report the first case in which massive haemoptysis from an asper-gilloma has been treated with radiotherapy and suggest that this method should be more widely used when there are contraindications to surgery. Case report This man (AK), aged 42 years, presented in February 1979 with three haemoptyses of about 150 ml each within 36 hours. On the day after admission to hospital he had a larger haemoptysis which caused a respiratory arrest requiring hand ventilation for an hour and a blood transfusion of four units. He had a smaller haemoptysis that evening and a week later bled about 700 ml; again he required intubation and hand ventilation. He had had asthma since the age of 4 years and had positive prick tests to house dust, grass pollen, dog hair, cat fur, feather, and A spergillus fumigatus. Since 1962 his symptoms had been worse in winter. Transient shadows were first noticed on the chest radiograph in 1967 at which time aspergillus precipitins were present and his blood eosinophil count was 0 72X 109/l. A diagnosis of allergic bronchopulmonary aspergillosis was made and by 1971 bilateral upper lobe shrinkage was already present. By 1979 he was dyspnoeic on climbing one flight of stairs, had a cough with a small amount of yellow sputum in the mornings, but had had no previous haemoptyses. On examination he was thin, kyphotic, and centrally cyanosed. Finger clubbing was present and there were widespread wheezes and crackles. His chest radio-graph showed bilateral upper lobe contraction with bronchiectasis on the right and a large aspergilloma, confirmed by tomography, on the left. Sputum was negative for tubercle bacilli and malignant cells. His precipitins to A spergillus fumigatus were strongly positive and total IgE was greater than 4000 international units/ml. Fibreoptic bronchoscopy confirmed that the bleeding was coming from the left upper lobe.