대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 820 Date 2013-07-15

  • Courtesy of Ji-Yeon Han, Ki-Nam Lee, Eun-Ju Kang / Dong-A University Hospital
  • Age/Sex 44 / F
  • Chief ComplaintRt flank pain for three months
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

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
Keywords
Lung, infection, Bacterial infection,

No. of Applicants : 58

▶ Correct Answer : 15/58,  25.9%
  • - Kyoto University , Japan Akihiko Sakata
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Tong young Red cross hospital , Korea (South) Lee Kwang Jin
  • - Dongtan Sacred Heart Hospital , Korea (South) Younghwan Ko
  • - NMCTH , Nepal Dipesh paudel
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Saint Malo , France jean-baptiste Noel
  • - , Korea (South) Kim sungmo
  • - Himeji St.Mary Hospital , Japan Yuichiro Kanie
  • - Fukuyama city hospital , Japan Ryotaro Kishi
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
▶ Correct Answer as Differential Diagnosis : 9/58,  15.5%
  • - Asan Medical Center , Korea (South) Sanghyun Choi
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - All India Institute of medical sciences , India Justin Moses
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
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