[Endocavitary aspiration in the treatment of lung abscess].
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A diabetic patient with pneumonia of unspecified origin developed a lung abscess after therapy with ultrasonic nebulization. The etiologic organism was identified as Pseudomonas cepacia. Investigation determined the source of the organism to be the reservoir of the ultrasonic nebulizer, to which the patient was directly exposed through removal of the bottom of the disposable medication cup. When this organism is isolated a nosocomial source of infection should be suspected.
An immunocompetent 12-year-old boy developed multiple microaerophilic streptococcal lung abscesses after application of orthodontic bands ("braces"). The dental work was done in the supine position. The data suggest that the patient aspirated the organisms and, possibly, flecks of dental cement, during orthodontic treatment. "Rubber dams" should be used to help prevent aspiration in children who receive dental work in the supine position. When a rubber dam cannot be used, as with orthodontic treatment, physicians should advise patients who are at risk for developing pulmonary infection (eg, patients with neuromuscular diseases which compromise cough and/or gag, cystic fibrosis, sickle cell anemia, primary immunodeficiency, etc) to have this dental work, including orthodontic treatment, performed in the erect position.
Carney's syndrome consists of a combination of three rare tumours: gastric leiomyosarcoma, pulmonary chondroma and catecholamine-secreting paraganglioma. We describe a young woman with Carney's syndrome, who developed a lung abscess, due to obstruction of a bronchus by a chondroma, 11 yrs after having had a partial gastrectomy for a leiomyosarcoma.
We present the CT findings of pulmonary paragonimiasis in a 9-year-old girl. It appeared as a large cystic mass with an air-fluid level and simulated a lung abscess. Communication with a segmental bronchus was demonstrated well on a CT scan obtained after aspiration.
A 38-year-old man was admitted with persistent productive cough and right anterior chest pain. Chest X-ray showed two large masses connected with each other, one in the right lung field and the other in the anterior mediastinum. A tentative diagnosis of either lung abscess or bronchogenic carcinoma was initially made, because of elevated serum tumor markers (SLX and SCC) and persisting refractory inflammatory sings. However, open chest drainage revealed a few fine hairs and atheromatous materials within the masses, and the diagnosis of teratoma was made. We removed these masses, and investigated the reason for the elevation of tumor markers. Staining with SLX monoclonal antibody demonstrated that the pancreatic tissue in the masses contained SLX. Although this is the first reported case of teratoma producing tumor marker (SLX), it is highly possible that tumor markers may be elevated in the majority of patients with teratoma because of the genesis of this tumor.
The main causes of the development of chronic abscesses of the lungs in 41 patient were the presence of the pulmonary tissue sequesters, interlobar location of a process, large (5 cm and more) diameter of the cavities. The infiltrative form of an abscess was distinguished. The process should be considered as chronic in ineffectiveness of all the types of treatment. With the use of the conservative methods, 14 patients were cured.
The comparison of the clinical, laboratory and immunological indices in the patients with acute purulent lung abscess was carried out. The general and biochemical analysis of the blood was proved to reveal the signs of the acute inflammatory process presence independently on pathogenesis of the disease. The investigations of the immunological indices demonstrate the prevailing of humoral immune response to antigen. The suggested description of concomitant bronchitis was proved by the results of the cytological and the immunological study.
The immediate results of conservative (116 subjects) and surgical (37 subjects) treatment of patients with lung abscesses were studied and the remote outcomes were followed up for periods of 1 to 8 years in 104 therapeutically treated and 33 surgically treated patients. 13.7 and 40.4 per cent of the patients, respectively, were discharged from the hospital after complete and clinical recovery. In 41.6 per cent of the patients, chronic abscesses were stated. 4.3 per cent of the patients died. After the surgical treatment postoperative complications were observed in 51.3 per cent of the patients, fatal outcomes were stated in 10.8 per cent and 21.7 per cent of the patients were qualified as invalids. In the remote periods complete and clinical recovery was stated in 26.8 and 52.8 per cent of the patients respectively, 4 (4.1 per cent) patients died and 7.4 per cent of the patients previously engaged in manual work and 3.0 per cent of the patients previously engaged in mental work were qualified as permanent invalids.
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A 65-year-old man was seen with an asymptomatic solitary pulmonary nodule of at least five months' duration. Culture of a percutaneous needle aspirate yielded Pasteurella multocida. Surgical resection of the lesion showed an acute and chronic lung abscess histologically, and culture again yielded P multocida. The potential for this rare human respiratory tract pathogen to cause indolent, necrotizing parenchymal pulmonary infection in an asymptomatic patient is thus documented. The roentgenographic appearance of the lesion mimicked a primary carcinoma.
A clinical syndrome characterized by recurrent staphylococcal infection of the skin and respiratory tract from birth was described in 1966 and referred to as Job's syndrome. Marked hyperimmunoglobulinemia E was later found to be associated with this syndrome. This article describes a case of Job's syndrome as a cause of recurrent lung abscess during childhood necessitating lung resection.
Recently the number of amebiasis cases has increased in Japan. Pleuropulmonary amebiasis is a very rare complication of liver amebiasis. We report herein the case of a 54-year-old man presenting with an amebic lung abscess in his right lower lung. The diagnosis of lung amebiasis was established from a direct examination of the pus in which trophozoites of Entamoeba histolytica were detected. After the oral administration of metronidazole, the laboratory findings improved and he thus underwent a right lower lobectomy. He was discharged without any relapse of infection 20 days after a thoracotomy. We conclude that a protozoan infection should thus be suspected in the case of a pleuropulmonary infection in which several types of antibiotics prove to be ineffective.
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