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.

Patient was diagnosed with aspergilloma and was posted for VATS right upper lobectomy. CT scan of the chest revealed a partially collapsed right upper lobe with suspectedaspergilloma 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. Patient was induced and airway was secured with the double lumen tube. Isolation of the lung was confirmed with fibrescope. 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 distal to the opening of the right upper lobe bronchus. This was done under direct fiberoptic vision through the tracheal lumen of DLT after clamping. The cuff was inflated with 2 ml of air and an apparent good seal was obtained. Patient was then made supine to proceed with the plan.

With this approach we have advanced from side selective and protective to lobe selective and protective technique and hence better lung protection. Moreover we were able to achieve some degree of lung protection at the time of induction even before airway was secured.