대한흉부영상의학회 Weekly Chest Cases

Case No : 521 Date 2007-10-22

Courtesy of Hwan Seok Yong, MD, Eun-Young Kang, MD. / Korea University Guro Hospital, Korea.
Age/Sex 79 / M
Chief ComplaintIncidental finding on chest radiograph

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary Actinomyocosis
Radiologic Findings: Chest CT shows about 1.7 cm-sized heterogeneous nodule with adjacent fibrotic opacities, internal low density and calcification in RUL posterior segment. Enlarged lymph node is also seen in right hilar area.
Brief Review: Thoracic actinomycosis is a chronic suppurative pulmonary infection caused by Actinomyces species, most frequently Actinomyces israelii, a gram-positive anaerobic saprophytic organism in the oral cavity that historically was thought to be fungus, but now is considered to be a branching filamentous bacterium.
The typical CT feature of parenchymal actinomycosis is a chronic segmental air-space consolidation containing necrotic low-attenuation areas with frequent cavity formation. Findings of chronic segmental air-space consolidation that contained low-attenuation areas with peripheral enhancement or adjacent pleural thickening at CT were suggestive of thoracic actinomycosis.
References: 1. Cheon, J.E., et al., Thoracic actinomycosis: CT findings. Radiology, 1998. 209(1): p. 229-33.
2. Kim, T.S., et al., Thoracic actinomycosis: CT features with histopathologic correlation. AJR Am J Roentgenol, 2006. 186(1): p. 225-31.
Keywords: Lung, Infection, Bacterial infection,

No. of Applicants : 45

▶ Correct Answer as Differential Diagnosis : 3/45, 6.7%

- Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
- Jackson Memorial Hospital, Florida, USA N.B.S.Mani
- Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo

▶ Semi-Correct Answer : 37/45, 82.2%

- Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- CHRU Lille hopital calmette, France Toledano Manuel
- Pune, India Rahul Deshmukh
- Trakya University Edirne Turkey Armagan Sarac
- Regional Imaging Riverina, Australia Rashid Hashmi
- Lilavati Hospital & Rsearch Centre, Mumbai, India Mahavir Swami
- Dept. of radiology, Assam medicalcollege, Assam, India Karunakaran M
- Ondokuz Mayis University, Samsun Turkey Cetin Celenk
- Nirman Hitech CT MR centre & Apollo clinic, Mumbai, India Jeshil Shah
- Jiangsu Province Official Hospital, Nanjing, Jiangsu Province, China Dong Sheng Jin
- Registrar in Radiology, UHL NHS Trust, UK. A. Donuru
- Sinsegye Rad Clinic, Daegu, Korea Kim Gi Beom
- Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
- Armidale Radiology, Australia Saurabh Khandelwal
- Pittwater Radiology, Australia Julie Arora
- VIVUS SMRC Heart centre, Goa, India Paresh Desai
- Osaka University, Japan Osamu Honda
- Gimpo Woori Hospital, Korea Son Youl Lee
- Kasturba Medical Collage, Manipal, Karnataka, India Naveen M Kulkarni
- IRSA La Rochelle, France Jean-Luc BIGOT
- National Taiwan University Hospital, Taipei, Taiwan Chin Chung Shu
- Kangnam sacred hospital, Korea Jae Won Kim
- Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
- IRSA, La Rochelle, France Denis Chabassiere
- Vital imaging centre, Mumbai, India Ganesh Agrawal
- Asan medical center, Seoul, Korea Dae Yoon Kim
- CHU Grenoble, France Bing Fabrice
- Annecy hospital, France Gilles Genin
- EKH-Berlin, Germany Michael Weber
- Hospital Sotiria, Athens, Greece Vasilios Tzilas
- Nassau, Bahamas Trupti Dabholkar
- China Medical University Hospital, Taiwan Jun-Jun Yeh
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- UltraCare, Coimbatore, India Debabrata Das
- Soonchunhyang University Cheonan Hospital, Korea Sang Hyun Park
- E-Da hospital, Taiwan Yu-Feng Wei
- Max Hospital, New Delhi, India Vickrant Malhotra

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 521 Date 2007-10-22

Discussion

No. of Applicants : 45