Clinicopathological conference; lung abscess.
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Oesophageal moniliasis is reviewed and the incidence of fistula formation discussed. A case of oesophageal moniliasis without any predisposing factors, with fistula formation and lung abscess, is presented.
Two cases of severe community-acquired pneumonia requiring IPPV and complicated by the development of lung abscess were successfully treated with early surgical drainage. This procedure may be a life-saving measure in certain instances.
We report a case of Rhodococcus equi, an unusual pathogen, causing a right upper lobe lung abscess in a patient with Evan's syndrome (auto-immune haemolytic anaemia and thrombocytopenia) who was treated with high-dose corticosteroid therapy. The patient was treated successfully with clarithromycin, vancomycin, ciprofloxacin and imipenen which appear to be effective in combination for this unusual condition in which the treatment regimen has been controversial.
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A 79-year-old man was hospitalized because of staphylococcal sepsis, and subsequently died from massive hemoptysis. Autopsy revealed a lung abscess which had eroded into the aorta. Severe atherosclerosis of the aorta may have been an important contributing factor.
We report a case of lung infection by Pseudallescheria boydii, which appeared during therapeutic aplasia in a patient with acute leukaemia. The association of sudden chest pain and fever with negative blood cultures and haemoptysic expectoration first suggested a diagnosis of pulmonary aspergillosis, in particular because evidence of lung abscesses appeared very rapidly and large mycelial filaments were found on direct examination of the expectoration. Pseudallescheria boydii was identified by culture. Investigations in vitro of the effects of antimycotics showed that the micro-organism was resistant to amphotericin B and sensitive to imidazoles. The clinical and radiological outcome after treatment with ketoconazole was favourable.
The immune and fibrinolytic systems were studied in 55 patients with postpneumonic lung abscess; 17 of them were operated on. Revealed were reductions of the number and functional activity of the T-cell immunity and a systemic-regional fibroanalysis data (high fibrinolytic activity in the systemic circulation and bronchial lumen; high activity in the blood of the resected lung portion). High activator activity of the sputum and its absence in the pus of the abscess cavity evidence that the source of the plasminogen activator is the bronchial wall not the destructed pulmonary tissue.
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Pulmonary abscess is an infrequent but significant problem in children. We retrospectively reviewed the charts of 45 children with documented lung abscesses admitted and treated at Texas Children's Hospital, Houston, over the 11-year period from January, 1982, to December, 1993, and report their presenting symptoms, bacteriology, clinical management and outcome.
A 28-year-old female developed infective endocarditis in the tricuspid valve and multiple lung abscesses due to septic pulmonary emboli early after intensive therapy for ulcerative colitis. The pathogen was methicillin-resistant Staphylococcus aureus. Usual antibiotic agents and linezolid were administered. Three weeks later, she fell into cardiopulmonary arrest due to further pulmonary emboli and required mechanical circulatory assist. Fatal brain damage was suggested at first. Two days later, she fully regained consciousness and underwent tricuspid valve replacement using mechanical valve and extirpation of septic pulmonary embolus. Mechanical circulatory assist was discontinued on the next day. After strenuous administration of linezolid and other drugs for 9 weeks, she was discharged from hospital on foot. We believe that early surgical intervention should be considered in patients with infective endocarditis in the right heart and subsequent septic pulmonary emboli. Linezolid was very useful in this patient.
Three cases who presented with life threatening haemoptysis are reported, all of whom required surgery to control the bleeding. In all three patients chronic lung abscess was responsible for the haemoptysis. Even in the absence of typical clinical or radiographic features of an abscess this diagnosis should be considered in any patient presenting with life threatening haemoptysis.
Treatment of 76 children aged from 1 month to 14 years with acute destructive pneumonia complicated by intrapulmonary abscesses is described. The treatment was complex, general, antibacterial and local. The authors have elaborated a method of percutaneous prolonged catheterization of lung abscesses in children which was used in 22 patients. The method resulted in sanitation of the blocked intrapulmonary abscesses, prevention of severe complications and shorter treatment of the patients at the hospital.