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Weekly Chest CasesArchive of Old Cases

Case No : 858 Date 2014-04-07

  • Courtesy of Kyung Hee Lee, Tae Jung Kim / Bundang Seoul National University Hospital
  • Age/Sex 41 / M
  • Chief Complaintcough, sputum, and intermittent fever for 2 weeks
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initial chest PA

Diagnosis With Brief Discussion

Diagnosis
Pulmonary actinomycosis
Radiologic Findings
Initial chest PA shows several nodular opacities with cavitary change in the right upper and lower lung field. Chest CT demonstrates multiple ill-defined cavitary nodules in the RUL, LUL lingular and RLL anterobasal segment. The central portion of the cavitary nodules contains necrotic low attenuation with air-fluid level. The peripheral portion shows rim enhancement with surrounding ill-defined consolidation. Mild enlargement of subcarinal and right interlobar LNs was also noted. CT-guided biopsy was performed for the RUL lesion, and it revealed actinomycotic colonies with abscess. Two months after amoxicillin-clavulanate treatment, follow-up chest PA reveals improvement of previous nodular opacities in right lung field.
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 form with the slow progression. 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.
Please refer to
Case 820, Case 751, Case 536, Case 521, Case 442, Case 412, Case 324, Case 197, Case 174,
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 : 89

▶ Correct Answer : 3/89,  3.4%
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - 異⑸ , Korea (South) Junghwan Kim
▶ Correct Answer as Differential Diagnosis : 26/89,  29.2%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - , Korea (South) Chan Park
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - Chonnam Nationl University Radiology , Korea (South) juwon kim
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - , Korea (South) Kim sungmo
  • - CHU Poitiers , France CHAN paul
  • - Chonnam National Univ. Hospital , Korea (South) Jaemyeong Jo
  • - CNUH , Korea (South) lee jin
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - chungbuk national university hospital , Korea (South) jeehye kim
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Japanese national center of neurology and psychiatry , Japan Kaoru Sumida
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Private sector , Greece Vasilios Tzilas
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Oita University , Japan Haruka Sato
  • - kanto Rosai Hp , Japan Takana Yamakawa
  • - TCM HOSPITAL OF ZIGONG , China Cao Cunyou
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