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Weekly Chest CasesArchive of Old Cases

Case No : 1100 Date 2018-11-27

  • Courtesy of Yoon Young Choi, Kun Il Kim, MD. / Pusan National University Yangsan Hospital
  • Age/Sex 77 / M
  • Chief ComplaintCough, sputum
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Pulmonary actinomycosis
Radiologic Findings
Figs 1. Chest PA shows a huge mass in the left hemithorax and another mass in right upper lung zone.
Fig 2-4. Contrast-enhanced chest CT scan shows a huge multiloculated cavitary mass in the left hemithroax with several foci of septal calcification. Another small mass with similar features is seen at right upper lobe.
Figs 5-7. Previous CT images performed seven years ago.

CT-guided biopsy was performed at left basal lung zone, which revealed the mass to be actinomycosis. Due to the risk associated with extensive surgery, the patient is currently under observation with ampicillin treatment after abscess drainage.
Brief Review
Parenchymal patterns of pulmonary actinomycosis include a peripheral pulmonary nodule, mass, or consolidation, all of which may or may not be cavitary or multifocal. Typical CT findings are reported as central areas of low attenuation within the consolidation in 62-75 % of cases and adjacent pleural thickening in 50-73 %. The disease initially manifests as a small, poorly defined, peripheral pulmonary nodule with or without interlobular septal thickening. The pulmonary nodule gradually increases to segmental air-space consolidation, which suggests bronchogenic spread of the disease. If therapy is not adequate, central areas of low attenuation with a cavity slowly develop. Central low-attenuation areas may be multiple and variable in size and show rim-like peripheral enhancement on enhanced CT. Histologically, central low-attenuation areas seen on CT represent microabscesses, which contain actinomycotic or sulphur granules. The peripheral enhancing portion is composed of an outer rim of granulation tissue and fibrosis. The differential diagnosis of the parenchymal type should include tuberculosis, bacterial or fungal necrotizing pneumonia, and lung cancer.
References
1. Han JY, Lee KN, Lee JK, et al. An overview of thoracic actinomycosis: CT features. Insights Imaging 2013;4:245-252.
2. Kim TS, Han J, Koh W, et al. Thoracic Actinomycosis: CT Features with Histopathologic Correlation. AJR 2006;186:225-231.

Keywords
Lung, Infection, Bacterial infection,

No. of Applicants : 67

▶ Correct Answer : 16/67,  23.9%
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Chungbuk National University College of Medicine , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - , Turkey EGEMEN
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - Ajou University Hospital , Korea (South) DAYOUNG KIM
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
▶ Correct Answer as Differential Diagnosis : 15/67,  22.4%
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Chonbuk National University Hospital , Korea (South) SANGHEON KIM
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - , Japan NAOMI YUASA
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
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