대한흉부영상의학회 Weekly Chest Cases

Case No : 412 Date 2005-09-19

Courtesy of Kijun Kim, MD. / Dept. of Radiology, Our Lady of Mercy Hospital, The Catholic University
Age/Sex 51 / M
Chief ComplaintWorsening of dyspnea and cough for one week

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Diagnosis With Brief Discussion

Diagnosis: Actinomycosis
Radiologic Findings: Chest radiograph revealed ill-defined cavitary consolidation in the right upper lobe. High-resolution CT showed ill-defined consolidation with multiple cavities in right upper lobe. Contrast-enhanced CT scan showed multiple cavities and low-attenuation areas with enhancing rim in the consolidation.

Percutaneous CT-guided needle aspiration was performed and the histopathologic findings showed a typical sulfur granule containing Actinomyces colony surrounded by polymorphonuclear cells.
Brief Review: Thoracic Actinomycosis is an uncommon bacterial infection. The organisms are normal inhabitants of oropharynx and are frequently found at gingival margins of persons with poor oral hygiene. Usually, the spread of infection occurred directly from the oropharynx into the lung by aspiration.

The typical pattern of radiologic manifestation consists of air-space consolidation, without recognizable segmental distribution, commonly in the periphery of the lung and with a predilection for the lower lobes. Usually the infection may extend into the pleura and chest wall. Recently, chest wall involvement is rarely seen probably due to earlier diagnosis and more effective antibiotics treatment. Other atypical findings include a mass, frequently cavitated, miliary disease, multiple nodules, bilateral apical opacities and endobronchial nodule with obstructive pneumonopathy (1).

Thoracic CT findings were reported as findings of chronic segmental air-space consolidation that containing low-attenuation areas with peripheral enhancement or adjacent pleural thickening (2).
References: 1. Fraser RS, M?ler NL, Colman N, Par?PD. Diagnosis of disease of the chest. Philadelphia: Saunders, 1992; 952-957.

2. Cheon JE, Im JG, Kim MY, Lee JS, Choi GM, Yeon KM. Thoracic Actinomycosis: CT findings. Radiology 1998;209:229-233.
Keywords: Lung, Infection, Bacterial infection,

No. of Applicants : 35

▶ Correct Answer : 4/35, 11.4%

- Jecheon Hyundai Hospital, Korea Seung Hun Ryu
- Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
- Kosin University Gospel Hospitalm Busan, Korea Mi Hee Jung
- Dong-Eui Medical Center, Busan, Korea Hoon Sik Jung

▶ Correct Answer as Differential Diagnosis : 11/35, 31.4%

- Yonsei University Hospital, Korea Eun Hye Yoo
- Ping-Tung Christian Hospital , Taiwan Chi-Kuei Hsu
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi
- Radiologie Guiton, La Rochelle, France Denis Chabassiere
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Annemasse, Polyclinique de Savoie, France Gay-Depassier
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Max Hospital, New Delhi, India Vickrant Malhotra
- Ping Tung Christian Hospital,Taiwan Jun-Jun Yeh

▶ Semi-Correct Answer : 15/35, 42.9%

- 166 MH Hospital R Kapur
- Kyungpook National University Hospital, Korea Han Young Jung
- Hereford County Hospital, UK Joy A Thomas
- Max Hospital, New Delhi, India Anurag Jain
- Busan National UniversityHospital, Korea Su-mi Shin
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
- Fleury Medical Center, Brazil Gustavo Meirelles
- Pgimer, Chandigarh, India Ramprakash Galwa
- Kosin University Bokum Hospital, Korea Seong Hyup Kim
- ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi
- G.T.B. Hospital, Delhi, India Lalendra Upreti
- Incheon Sarang Hospital, Incheon, Korea Jung Hee Kim
- Monaldi Hospital, Naples, Italy Gaetano Rea
- Annecy Hospital, France Gilles Genin
- Daejon St Mary's Hospital ChaeHun Lim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 412 Date 2005-09-19

Discussion

No. of Applicants : 35