CASE REPORT Postoperative Bleeding from the Pulmonary Artery Stump Due to Inflammatory Erosion Caused by Aspergillus Infection: First Case of the Literature Güntuğ Batıhan 1 & Ozan Usluer 1 & Şeyda Örs Kaya 1 Received: 18 November 2019 /Accepted: 1 April 2020 # Association of Surgeons of India 2020 Abstract The term aspergillosis describes the disease caused by Aspergillus species. The most common pathogen in this genus is Aspergillus fumigatus. Anatomic pulmonary resection is the preferred treatment modality in most of cases especially the presence of the localized disease, but sometimes patients complicate by prolonged air leakage, pleural space problems, and infection of this residual space. We reported a patient who undergone left upper lobectomy because of aspergilloma in the left upper lobe. After the operation, the patient’ s condition became complicated because of expansion failure of the lung and space problems. After the period of conservative treatment, urgent re-operation was needed because of acute hemorrhage from the chest tube. Hemorrhage was controlled, but disseminated pleural aspergillosis and infection in the pulmonary arterial stump were seen in the thoracic cavity. Completion pneumonectomy and pleural decortication were applied, and the antifungal therapy was arranged. With this report, we aim to evaluate the relation between disseminated pleural aspergillosis and inflammatory erosion of pulmonary arterial stump. It is also important to consider possibility of dissemination of the Aspergillus infection especially in patients with expansion failure after lung resection. Keywords Arterial stump . Aspergilloma . Hemorrhage . Lung resection . Pleural dissemination Introduction Aspergillus fumigatus is an opportunistic fungal patho- gen, and its spores called conidia are found widely in the environment [1]. Inhalation of these spores does not cause any clinical condition and eliminated by mucociliary clearance and innate immune mechanisms in healthy people. In the presence of immune deficiency, allergic status, or chronic parenchymal pathologies, different kinds of presenta- tion of Aspergillus infection would be seen. All these clinical conditions are grouped under a general heading as “Aspergillus-related lung diseases.” [2]. In this case, we reported a mortal progression of aspergilloma to invasive pulmonary aspergillosis after lung resection. Case Report A 66-year-old man was admitted to our clinic with a complaint of bloody sputum. He did not describe fever, weakness, and loss of appetite. Plane chest radiography was taken, and it revealed cavitary opacity in the left upper zone (Fig. 1a); therefore, a chest computed to- mography (CT) scan is planned. Chest CT revealed pa- renchymal opacity surrounded by an “air crescent” in the left upper lobe (Fig. 1b). According to these clinical and radiological findings, the patient was diagnosed with saprophytic pulmonary aspergil- losis (aspergilloma). The patient’ s hemoptysis was mild, and respiratory parameters were suitable for lung resection; there- fore, surgical intervention is preferred instead of pulmonary artery embolization. * Güntuğ Batıhan gbatihan@hotmail.com 1 Department of Thoracic Surgery, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, Yenişehir, Gaziler Street 331, 35110 Izmir, Turkey Indian Journal of Surgery https://doi.org/10.1007/s12262-020-02179-x