Abstract
Objective Necrotizing pneumonia, pulmonary abscess, and lung gangrene are rare complications
of severe pulmonary infection with devitalization and sloughing of lung tissue. Pulmonary
necrosis is often associated with alcoholism and other chronic disorders with known
immunodeficiency. Mortality is significant and both treatment strategies as well as
the role of surgery are controversially debated.
Methods In a retrospective review at a German tertiary referral hospital, 20 patients with
pulmonary resection for necrotizing lung disorders were identified since 2008. At
hospital admission, all patients suffered from pulmonary sepsis and despite adequate
medical treatment progressing parenchymal destruction and devitalization took place.
The majority of the patients sustained pleural empyema (13/20) and five patients a
persisting air leak. On account of failing medical therapy, eight patients (40%) developed
severe sepsis with septic shock and four patients (20%) were already preoperatively
ventilated. Chronic alcoholism was present in 10 patients (50%).
Results Gangrene of a complete lung was seen in four cases. Lobar gangrene or necrotizing
pneumonia complicated by fulminate abscess was seen in the right lower lobe (8/20),
middle lobe (4/20), right upper lobe (2/20), and left lower lobe (2/20). Procedures
included pneumectomy (4/20), lobectomy (13/20), and limited resection (3/20). The
bronchial stump was reinforced with a pedicle muscle flap in seven cases. There were
three postoperative deaths due to septic shock with multiorgan failure. The remaining
17 patients (85%) recovered well and were transferred to rehabilitation clinics specialized
on pulmonary disorders.
Conclusion Necrotizing pulmonary infections are infrequent but are life-threatening disease
entities. Patients often present with severe comorbidity and chronic disorders causing
immunodeficiency. If initial medical therapy fails surgery offers a reasonable therapeutic
approach. Aim of surgical therapy is resection of all gangrenous lung parenchyma and
effective drainage of pleural empyema. Then recovery is feasible in up to 80%.
Keywords
necrotizing pneumonia - lung gangrene - lung abscess
