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DOI: 10.1055/s-0030-1271180
Surgery for Inflammatory Tumor of the Lung Caused by Pulmonary Actinomycosis
Publikationsverlauf
15. Januar 2011
21. März 2011
23. April 2011
Publikationsdatum:
21. Juni 2011 (online)
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Abstract
Background Actinomycosis is an uncommon chronic suppurative bacterial infection caused by anaerobic bacteria. Pulmonary actinomycosis is even more infrequent and generally simulates a wide variety of pulmonary disorders including tuberculosis and lung cancer. Therefore delayed diagnosis and misdiagnosis is common. Here, actinomycosis was initially confused with pulmonary carcinoma.
Methods We report on three cases of inflammatory tumors caused by pulmonary actinomycosis. All three patients were male and had a history of alcoholism and poor oral hygiene associated with dental disease. Clinical symptoms were nonspecific and radiographic imaging showed tumor-like mass lesions not distinguishable from neoplasms. Preoperative bronchoscopy, sputum culture, laboratory tests and bronchoalveolar lavage neither confirmed an infectious disease nor ruled out lung cancer. Hence all patients underwent thoracotomy for both diagnosis and definitive treatment. Intraoperatively we encountered a necrotizing infection forming cavitary as well as tumorous lesions and a lobectomy was performed due to destroyed lung tissue. In one case the tumorous lesion involved the chest wall so that partial resection of the 3rd rib with the adjacent soft tissue was mandatory.
Results Histological examination of the pulmonary specimen established the diagnosis of pulmonary actinomycosis. All patients recovered well and received antibiotic therapy with oral penicillin.
Conclusions The diagnosis of pulmonary actinomycosis remains challenging. In cases of an inflammatory tumor imitating lung cancer, surgical resection is mandatory, both to confirm the diagnosis and for the definitive treatment in cases with irreversible parenchymal destruction. Here, surgery in combination with medical treatment offered reliably excellent results.
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References
- 1 Mabeza GF, Macfarlane J. Pulmonary actinomycosis. Eur Respir J 2003; 21: 545-551
- 2 Gadkowski LB, Stout JE. Cavitary pulmonary disease. Clin Microbiol Rev 2008; 21: 305-325
- 3 Song JU, Park HY, Jeon K, Um SW, Kwon OJ, Koh WJ. Treatment of thoracic actinomycosis: a retrospective analysis of 40 patients. Ann Thorac Med 2010; 5: 80-85
- 4 Hsieh MJ, Liu HP, Chang JP, Chang CH. Thoracic actinomycosis. Chest 1993; 104: 366-370
- 5 Madhusudhan KS, Gamanagatti S, Seith A, Hari S. Pulmonary infections mimicking cancer: report of four cases. Singapore Med J 2007; 48: 327-331
- 6 Jensen BM, Kruse-Andersen S, Andersen K. Thoracic actinomycosis. Scand J Thorac Cardiovasc Surg 1989; 23: 181-184
- 7 Houdelette P, Simon A, Garola P, Hervé P. Pseudo-neoplastic aspects of thoracic actinomycosis. J Chir (Paris) 1992; 129 (4) 206-209
- 8 Tastepe AI, Ulasan NG, Liman ST, Demircan S, Uzar A. Thoracic actinomycosis. Eur J Cardiothorac Surg 1998; 14 (6) 578-583
- 9 Lu MS, Liu HP, Yeh CH , et al. The role of surgery in hemoptysis caused by thoracic actinomycosis; a forgotten disease. Eur J Cardiothorac Surg 2003; 24: 694-698
- 10 Endo S, Murayama F, Yamaguchi T , et al. Surgical considerations for pulmonary actinomycosis. Ann Thorac Surg 2002; 74 (1) 185-190
- 11 El Ghannam H, Bai C, Qiao R. Pulmonary actinomycosis presenting as a mass-like consolidation. South Med J 2010; 103 (1) 81-83
- 12 Hsieh MJ, Shieh WB, Chen KS, Yu TJ, Kuo HP, Tsai YH. Pulmonary actinomycosis appearing as a “ball-in-hole” on chest radiography and bronchoscopy. Thorax 1996; 51: 221-222
- 13 Kremer H, Röss M. Thoracic actinomycosis masquerading as a central bronchial carcinoma. Dtsch Med Wochenschr 1993; 118 (32) 1150-1154
- 14 Kobashi Y, Yoshida K, Miyashita N, Niki Y, Matsushima T. Thoracic actinomycosis with mainly pleural involvement. J Infect Chemother 2004; 10 (3) 172-177
- 15 Enders M, Reitnauer K, Girmann M, Lindemann W, Ukena D, Sybrecht GW. Thoracic actinomycosis – a case report. Pneumologie 1999; 53 (4) 216-218
- 16 Wong RHL, Sihoe ADL, Thung KH , et al. Actinomycosis: an often forgotten diagnosis. Asian Cardiovasc Thorac Ann 2004; 12: 165-167
- 17 Abdalla J, Myers J, Moorman J. Actinomycotic infection of the oesophagus. J Infect 2005; 51 (2) E39-E43
- 18 Aldaqal SM, Bakhsh TM, Amarhabi YA, Fakiha MG. Thoracic actinomycosis presented with tracheoesophageal fistula and fatal pulmonary infection. Saudi Med J 2004; 25 (10) 1471-1473
- 19 Moller-Jensen B, Kruse-Andersen S, Andersen K. Thoraco-pleural actinomycosis presenting like diffuse pulmonary embolism. Thorac Cardiovasc Surg 1988; 36 (5) 284-286
- 20 Rizzi A, Rocco G, Della Pona C , et al. Pulmonary actinomycosis: surgical considerations. Monaldi Arch Chest Dis 1996; 51 (5) 369-372
- 21 Ferreira Dde F, Amado J, Neves S, Taveira N, Carvalho A, Nogueira R. Treatment of pulmonary actinomycosis with levofloxacin. J Bras Pneumol 2008; 34 (4) 245-248
- 22 Yew WW, Wong PC, Lee J, Fung SL, Wong CF, Chan CY. Report of eight cases of pulmonary actinomycosis and their treatment with imipenem-cilastatin. Monaldi Arc Chest Dis 1999; 54 (2) 126-129