Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Actinomycosis
- Radiologic Findings
- Chest CT shows heterogeneously enhancing mass with adjacent pleural thickening in right lower lobe. The diaphragm and diaphragmatic pleura near the lung mass show thickening, continuous with the hepatic mass in coronal reconstructed chest CT. Following abdominal pelvic CT shows multiple peripherally enhancing hepatic masses, invading hepatic flexure of colon.
The patient underwent operation for removal of left adnexal mass. The frozen specimen showed acute and chronic inflammation suggesting actinomycosis. Right adnexal cystic mass was diagnosed as mature cystic teratoma. After the 2 months of Penicillin treatment, lung mass and hepatic mass show marked improvement.
abdomen CT
abdomen CT
Two months after pecicillin treatment
- Brief Review
- Actinomycosis produces proteolytic enzymes so that the organism may spread from the lung to the pleura, mediastinum and chest wall, with little regard for anatomic barrieres. The present case manifests hematogenous dissemination to liver from pelvis, direct invasion into lung from the hepatic mass through diaphragm, showing destructive nature of this organism.
The thoracic form (accounting 15-50% of the total burden of the disease) of actinomycosis is characterized by consolidation with central low density (62-75%) with adjacent pleural thickening (50-73%) on chest CT. Not uncommonly, the infection presents as a mass, that mimics malignancy as with our case. Thoracic actinomycosis is generally secondary to aspiration of infected material through the orophraynx. However the present case is secondary to direct invasion from the hepatic mass. Pelvic actinomycosis manifests mostly solid masses with focal low attenuation areas, or sometimes cystic masses with thickened walls. After local establishing of actinomycosis, a slowly progressive hematogenous spread is possible.
- References
- 1. Han JY, Lee KN, Lee JK, et al. An overview of thoracic actinomycosis: CT features. Insights Imaging 2013;4:245-252
2. Ros LH, Villacampa VM, Torres GM, Ros PR. Thoracoabdominal actinomycosis mimicking metastatic disease: case report. Can Assoc Radiol J 1999;50:384-386
3. Ha HK, Lee HJ, Kim H, et al. Abdominal Actinomycosis: CT findings in 10 patients. AJR 1993;161:791-794
4. Apotheloz C, Regamey C. Disseminated infection due to Actinomyces meyeri: case report and review. Clin Infect Dis 1996;22:621
- Please refer to
- Case 751 Case 536 Case 521 Case 442 Case 412 Case 324 Case 197 Case 174
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- Keywords
- Lung, infection, Bacterial infection,