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PubMed1996

Brain abscesses: the lung connection.

Pulmonary arteriovenous fistulas are uncommon abnormalities of capillary development which cause right to left shunting and, if not treated, may lead to severe neurological complications, including meningitis and brain abscess. Pulmonary arteriovenous fistulas are commonly a result of hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease) and both conditions may be readily diagnosed by careful history taking and physical examination. Two cases of brain abscess associated with hereditary haemorrhagic telangiectasia, which remained unrecognized for many years, are reported. These cases emphasize the importance of early diagnosis and treatment of pulmonary arteriovenous fistula in preventing central nervous system infections.

Adult↗
PubMed2005

[Diagnosis of aspiration pneumonia complicated by acute purulent destruction in persons having risk factors].

OBJECTIVE: To analyze the causes of development of aspiration pneumonia (AP) complicated by acute purulent pulmonary destruction (APPD) and to optimize approaches to its diagnosis, by examining the clinical picture and features of its development in patients having risk factors. SUBJECTS AND METHODS: 431 patients with purulent pulmonary diseases, including 314 (72.8%) patients with abscessed pneumonia and 117 (27.2%) with lung abscesses. The aspiration mechanism of development of the diseases was established in 96 (22.3%) of the 431 patients. The patients' age ranged from 38 to 73 years. There were 87 males and 9 females. The episodes of massive aspiration of the contents of the stomach [45 (46.9%)], and oropharynx [15 (15.6%] and those of foreign body aspiration [36 (37.5%)] were analyzed. RESULTS: The aspiration mechanism of development of the diseases was established in 96 (22%) of the 431 patients with APPD, which accounted for 22.3%. Alcoholic disease was the underlying background disease in most (89.85%) patients, which permits alcoholism to be considered to be one of the major risk factors of the aspiration syndrome. Aspiration with the gastric food contents from the oral cavity was predominant, which makes it possible to consider dysphagia to be one of the most potent predictors of AP. Foreign body aspiration was established in 36 patients, among them 17 patients were found to have aspiration of fragments of teeth, dental fillings, and dentures. The aspiration mechanism of the disease was supported by history data, as established a documented episode of aspiration, by clinical, X-ray (esophageal and gastric roentgenoscopy and roentgenography) and endoscopic (fibrobronchoscopy, esophagogastroscopy) findings, as well as by the conclusions of an ENT specialist, a dentist, a neurologist, a narcological psychiatrist. The algorithm of the pathogenesis of AP and purulent lung diseases was proposed. CONCLUSION: Chronic alcoholism associated with peptic ulcer, chronic gastritis, and hepatic lesion (hepatitis/cirrhosis) is the most important predictor of AP and APPD. Complex clinical and X-ray examination including fibrobronchoscopy, esophagogastroscopy, 24-hour gastric juice pH-metry, and consultations of particular specialists are indicated to support the fact of aspiration.

Acute Disease↗
PubMed1978

The air meniscus as a radiographic finding: a review of the literature and presentation of nine unusual cases.

In addition to echinococcal cysts and mycetomas, a wide variety of disorders can occasionally produce an air meniscus sign on a chest radiograph. A proposed classification follows: I. Infections A. Lung abscess (with or without pulmonary gangrene) B. Fungus ball C. Bacterial ball D. Tuberculoma E. Blood clot in tuberculous cavity, Rasmussen aneurysm F. Echinococcal lung cyst II. Neoplastic A. Bronchogenic carcinoma B. Primary lung sarcoma C. Metastatic carcinoma, sarcoma to lung D. Bronchial adenoma E. Cystic hamartoma III. Developmental A. Bochdalek hernia (pseudocavity) IV. Traumatic A. Pulmonary hematoma V. Hemodynamic A. Congestive heart failure (with or without bullae)

Adult↗
PubMed1989

Post-traumatic pulmonary pseudocyst in the adult: pathophysiology, recognition, and selective management.

Pulmonary contusion is the usual manifestation of lung parenchymal injury following blunt chest trauma. With rapid deceleration, however, parenchymal lacerations can result in cavities best termed post-traumatic pulmonary pseudocyst (PPP). This report discusses eight adult PPP cases encountered at the Denver General Hospital over the past 30 months. Five were males and the mean age was 29 years (range, 18 to 54). Injury mechanism was motor vehicle accident in four, industrial machinery in two, autopedestrian accident in one, and large-animal rodeo rollover in another. Review of daily portable anteroposterior chest roentgenograms revealed parenchymal infiltrates consistent with pulmonary contusion that typically cavitated within the first week. Computed tomography of the chest was pursued in complicated patients and clearly influenced therapy. Three (38%) pseudocysts developed into lung abscesses; two required resection and the other responded to percutaneous drainage. Although previously described as a benign pediatric entity, in our adult experience, PPP may result in a recalcitrant lung abscess requiring aggressive intervention.

Adolescent↗
PubMed1991

Role of antibody to extracellular proteins of Rhodococcus equi in protection against R. equi pneumonia in foals.

Rhodococcus equi produces two exoenzymes (REE), a cholesterol oxidase in large amounts and a phospholipase C, which cause lysis of sheep red blood cells (SRBC) sensitized with Staphylococcus aureus beta toxin. Two immunization studies were done in foals to determine the role of antibody to REE in protection against R. equi pneumonia. In the first study, three foals (mean age 10 days) were vaccinated four times at 2-week intervals with over 1 million units of partially purified exoenzymes (PREE). In the second study, three foals (mean age 19 days) were administered plasma from an adult horse vaccinated with PREE. Relatively low titres (16-32) of neutralizing antibody were detected in the foals of the former group, and passive transfer of neutralizing antibody (titres 32-64) occurred in the latter. Following immunization, principal foals and an equal number of similarly aged nonimmunized foals were challenged by aerosol with 1 x 10(10) live R. equi per day for 5 consecutive days. No severe clinical pneumonia developed in either group and, with one exception, only minor and resolving lung abscesses developed in these foals. These studies showed that antibody response of foals to immunization with PREE was poor, antibody to PREE did not prevent foals from developing lung abscesses following experimental infection, and that foals even as young as 3 weeks of age may be largely refractory to aerosol challenge with virulent R. equi.

Actinomycetales Infections↗
PubMed1995

[Sarcoidosis with pulmonary abscess caused by emerging microorganisms].

The association sarcoidosis-lung abscess due to emerging microorganisms-mycetoma has prompted the authors to report the above clinical case which is interesting in view of the rarity of the disease and of its infective complications. The authors also review the literature on the subject.

Bronchoalveolar Lavage Fluid↗
PubMedDate not supplied

Transphrenic fistulization of a subphrenic abscess to lung parenchyma.

A 53-year-old woman was admitted with respiratory distress. For several years, she had chronic alcoholic pancreatitis with ductal stones that were treated with a stent and with shockwave lithotripsy. Both treatments were unsuccessful, and the pancreatitis was complicated with an infected pseudocyst. The pancreatic head had to be resected, which was complicated with recurrent subphrenic abscesses. She then was admitted with respiratory distress and initially diagnosed with pneumonia of the right lower lobe. Further investigations showed supradiaphragmatic and subdiaphragmatic air-fluid levels. In both collections Streptococcus milleri was cultured, and subsequently the patient was diagnosed with a fistula connecting the subdiaphragmatic abscess with pulmonary tissue. This was treated with intravenous amoxicillin/clavulanate and drainage of the subdiaphragmatic collection. She did not develop a pulmonary empyema, because multiple adhesions, which were due to recurrent abscesses after pancreatic surgery, prevented breakthrough into the pleural cavity.

Anti-Bacterial Agents↗
PubMed1987

Acute putrid abscess of the lung. By Harold Neuhof and Arthur SW Touroff. 1936.

This 51-year-old report detailed the principles of operative treatment of acute putrid abscess of the lung in the era prior to antibiotic availability. The technical aspects of the surgical approach advocated by Neuhof and Touroff were based on careful clinical and pathological review. In an era of increasing immunosuppressive therapy, both for transplantation and the treatment of malignant disease plus the emergence of new diseases such as acquired immune deficiency disease, there may be a re-emergence of lung abscess in patients too sick to undergo resection. Hence, the technique has present applicability.

Drainage↗
PubMed1998

[Detection of intrathoracic infectious lesions using In-diethylenetriamine pentaacetic bicyclic anhydride-IgG (111In-DTPA-IgG) scintigraphy].

The utility of 111In-DTPA-IgG imaging for the detection of intrathoracic lesions was evaluated in 10 patients with the suspicion of inflammatory or infectious diseases. They were intravenously administered 40 or 80 MBq of 111In-DTPA-IgG, and scanned after 24 or 48 hours. Of these, 8 cases, consisted of 4 cases with pneumonia and 2 cases with lung abscess and one case of pulmonary tuberculosis and one of a tuberculous pleuritis, showed true positive results. Others were one false negative case of pneumonia and one true negative case of lung cancer. Overall sensitivity and specificity were 88.9% and 100%, respectively. There were no cases which showed side effects or abnormal laboratory findings caused by the radiopharmaceuticals administered. Thus, 111In-DTPA-IgG imaging is a useful tool for the detection of intrathoracic infectious lesions.

Adenocarcinoma, Papillary↗
PubMedDate not supplied

Surgical repair of a liver injury in a patient: accompanied with tricuspid regurgitation.

A 42-year-old man with acute myocarditis developed a right lung abscess and tricuspid regurgitation with valvular vegetations. A chest tube was inserted from the 8th intercostal space on the anterior axillary line to drain acute thoracic empyema caused by rupture of the lung abscess. Six hours after the insertion, the patient went into shock. Since abdominal ultrasonography showed intraabdominal bleeding, an urgent laparotomy was performed. A large amount of blood was present in the peritoneal cavity. Pulsatile bleeding from the hepatic laceration and penetration of diaphragm were observed. Mattress sutures were used to close the hepatic laceration and the rent in the right hemi-diaphragm. Because the patient was hemodynamically stable postoperatively tricuspid valvular replacement was performed 5 days after the laparotomy. Four months after valve replacement, the patient is in good condition without any complaints.

Adult↗
PubMed2002

Unsuspected primary pulmonary malignant lymphoma.

A 70-year-old man referred for treatment of a left lower lung tumor was shown in chest computed tomography to have a homogeneous round tumor 45 mm in diameter with an enhanced thin wall in the lower lobe of the left lung. No specific finding was seen in material obtained by transbronchial and computed tomography (CT)-guided lung tissue biopsy, so the presumptive diagnosis was a lung abscess. Despite antibiotics administered for 2 weeks, radiography showed the tumor had grown, necessitating left lower lobectomy. The permanent section was diagnosed as diffuse large B-cell lymphoma. Because CT findings for the tumor suggested a lung abscess and the central part of the tumor consisted of fibrotic and necrotic tissue, we had difficulty establishing a final diagnosis. The literature showed primary pulmonary lymphomas yielded a variety of findings radiographically, making surgery paramount for ascertaining a final diagnosis.

Aged↗
PubMed1996

Clinical and imaging features of pulmonary strongyloidiasis.

We evaluated 20 patients with pulmonary strongyloidiasis for risk factors, clinical and imaging manifestations, complications, treatment, and outcome. Eighteen (90%) had risk factors for strongyloidiasis including steroid use, age greater than 65, chronic lung disease, use of histamine blockers, or chronic debilitating illness. Pulmonary signs and symptoms, including cough, shortness of breath, wheezing, and hemoptysis, were present in 19 (95%); adult respiratory distress syndrome (ARDS) developed in 9 (45%). Pulmonary infiltrates occurred in 18 (90%). Gastrointestinal signs and symptoms were also common. Peripheral blood eosinophilia occurred in 15 (75%). Twelve (60%) had secondary infection, and 3 (15%) had bacterial lung abscesses. All were treated with thiabendazole, 25 mg/kg twice daily; on average, patients without ARDS were treated for 3 days, versus 7 days for those with ARDS. Seventy percent responded to therapy; 30% died. Preexisting chronic lung disease and ARDS were statistically significant predictors of a poor prognosis.

Adolescent↗
PubMed2006

[Clinical analysis of bronchopulmonary infection with hypermastigotes: a report of two cases and review of the Chinese literature].

OBJECTIVE: To describe the clinical features of bronchopulmonary infection with hypermastigotes. METHODS: Two cases of bronchopulmonary infection with hypermastigotes were reported. The clinical features of another six cases from the Chinese literature were reviewed. RESULTS: Bronchopulmonary infection with hypermastigotes mostly occurs in the hot and humid southern area. The symptoms are severe, with different manifestations such as chronic cough, asthma, pneumonia, and even lung abscess. Final diagnosis is made by the presence of hypermastigotes in smears of secretions from the respiratory tract. An antiprotozoal such as metronidazole is always effective. CONCLUSION: In patients with unexplained cough, asthma, and pneumonia or lung abscess which do not respond to ordinary therapy, rare pathogens such as hypermastigotes need to be considered.

Bronchopneumonia↗
PubMed1998

[Pleuropulmonary manifestations of amebiasis].

Amibiasis is the third leading cause of death due to parasitic infections in the world. Amibiasis is endemic in the warm regions of the world with deficient hygiene and socio-economic situations. Entamoeba histolytica is the causal agent of invasive amibiasis, unlike Entamoeba dispar which is not a pathogen for humans. Amibian colitis and amibian abscess of the liver are the most frequent intestinal and extra-intestinal manifestations. Pleuropulmonary complications almost always occur in patients with a liver abscess, the intrathoracic contamination via transphrenic dissemination predominating. Respiratory signs are inaugural in 80% of the cases. Pleuropulmonary ambiasis designates the localization of the amibian infestation, but the clinical expression may vary: pneumonia, lung abscess, pleurisy, hepatobronchial fistulization and more infrequently pulmonary embolism. The preferential localization is the right hemithorax related to abscess in the right lobe of the liver. Left lobe abscesses lead to left-sided pleuropulmonary complications with the risk of rupture into the pericardium. Chocolate-colored pus from a pleural or abscess puncture or vomitus strongly suggests the diagnosis, which is confirmed by highly-positive serology. Metronidazole is the treatment of choice, providing cure without sequellae. In Africa, mortality and morbidity due to ambiasis are high. In Abidjan, 92% of cured patients have sequella, and mortality reaches 15%, the consequence of late diagnosis.

Amebiasis↗
PubMed1981

Yersinia enterocolitica lung infection.

A 66-year-old man had pneumonia, lung abscesses, and mediastinal adenopathy develop due to Yersinia enterocolitica. There was no evidence of septicemia or acute gastrointestinal disease. Diagnosis was confirmed by cultures of a transtracheal aspirate and sputum. Treatment with cefamandole nafate, which had not been used previously in Y enterocolitica lung disease, resulted in cure.

Aged↗
PubMed2000

Complications of nosocomial pneumonia in the surgical patient.

Nosocomial pneumonia is a leading cause of morbidity and mortality in the surgical and trauma patient. Inadequate treatment can lead to the complications of acute respiratory distress syndrome (ARDS), empyema, and lung abscess. The prevention and treatment of these complications revolve around several key principles. Complete treatment of pneumonia requires appropriate antimicrobial therapy, as well as mechanical pulmonary hygiene and proper airway management. Despite advances in treatment of pneumonia, complications arise necessitating treatment. This article reviews the treatment of ARDS, empyema, and lung abscesses. In particular, the many options for treatment of empyema are discussed in detail. Additionally, the treatment of pulmonary contusion and hemopneumothorax in the trauma patient is discussed. The understanding of sound treatment principles in the critically ill postsurgical patient helps prevent complicated or recurrent pneumonia and allows the surgeon to intervene effectively when such complications occur.

Journal Article↗
PubMed1994

[Imipenem/cilastatin sodium alone or combined with amikacin sulfate in respiratory infections].

In the present study, we used the envelope method to divide patients with respiratory infections into two groups: a monotherapy group given imipenem/cilastatin sodium (IPM/CS) and a combination therapy group given imipenem/cilastatin sodium plus amikacin sulfate (AMK). We then compared the clinical efficacy and safety between groups. 1. Safety was evaluated in 83 patients in the IPM/CS group and 88 in the IPM/CS + AMK group while clinical efficacy was evaluated in 77 and 80 patients in the respective groups. 2. The overall efficacy rate was 84.4% in the IPM/CS group. Among the main infections, the efficacy rates were 82.7% in 52 cases of pneumonia (including lung abscess), 100% in cases of infected bronchiectasis, 66.7% in six cases of secondary infection of chronic respiratory disease, and 100% in four cases of chronic bronchitis. The overall efficacy rate was 83.8% in the IPM/CS + AMK group. Among the main infections, the efficacy rates were 88.1% in 59 cases of pneumonia (including lung abscess), 83.3% in 12 cases of infected bronchiectasis, and 60.0% in five cases of secondary infection of chronic respiratory disease. No significant differences in efficacies were seen between groups. 3. In the IPM/CS group, the efficacy rates were 92.3% for patients without prior antibiotic therapy in the IPM/CS group and 68.0% for those with prior therapy; in the IPM/CS + AMK group, the respective rates were 83.7% and 83.9%. In the IPM/CS group, there was a significant difference in the responses of patients with and without prior antibiotic therapy (P < 0.05). 4. Side effects were observed in six patients in the IPM/CS group (7.2%) and two patients in the IPM/CS + AMK group (2.3%). Abnormal laboratory test results were noted in 5 patients in the IPM/CS group (6.0%) and in 10 in the IPM/CS + f1p4group (11.4%). There was no significant difference in the incidence of side effects between groups and no severe adverse reactions in either group. These results indicate that IPM/CS alone produces of good response in moderate to severe respiratory infections while IPM/CS combined with AMK is useful in intractable respiratory infections.

Adolescent↗