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Thorac Cardiovasc Surg 2012; 60(02): 156-160
DOI: 10.1055/s-0030-1271180
Special Reports
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgery for Inflammatory Tumor of the Lung Caused by Pulmonary Actinomycosis

M. Schweigert
1   Department of General and Thoracic Surgery, Klinikum Nuernberg Nord, Nuernberg, Germany
,
C. Meyer
2   Department of Pathology, Klinikum Nuernberg Nord, Nuernberg, Germany
,
R. J. Stadlhuber
1   Department of General and Thoracic Surgery, Klinikum Nuernberg Nord, Nuernberg, Germany
,
A. Dubecz
1   Department of General and Thoracic Surgery, Klinikum Nuernberg Nord, Nuernberg, Germany
,
D. Kraus
1   Department of General and Thoracic Surgery, Klinikum Nuernberg Nord, Nuernberg, Germany
,
H. J. Stein
1   Department of General and Thoracic Surgery, Klinikum Nuernberg Nord, Nuernberg, Germany
› Author Affiliations
Further Information

Publication History

15 January 2011
21 March 2011

23 April 2011

Publication Date:
21 June 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.

Key words

pulmonary actinomycosis - cavitary pulmonary disease - lung infection - septic thoracic surgery - pleural empyema
 

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