대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1371 Date 2024-01-30

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  • Courtesy of Hyun-ju Lim, Kun Young Lim, Soo-Hyun Lee, Hyae Young Kim / National Cancer Center
  • Age/Sex 61 / F
  • Chief ComplaintCough (onset 4 months ago) Blood tinged sputum (onset 1 month ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Actinomycosis
Radiologic Findings
Fig.1. Chest radiograph shows round nodular opacity in left lower lobe.

Fig. 2-3. Contrast-enhanced CT scan reveals mass mass-like elongated lesion with internal low attenuated area in left lower lobe.

Fig. 4. 18F-FDG-PET CT scan shows strong FDG uptake of left lower lobe mass lesion.
Brief Review
Thoracic actinomycosis is a rare chronic suppurative bacterial infection caused by actinomyces species, especially Actinomyces israelii.
Actinomyces infection typically follows aspiration of endogenous organisms of the oropharynx into lungs in patients with respiratory disorders such as emphysema or chronic bronchitis, poor oral hygiene, alcoholism, and chronic debilitating disease. It can occur from extension of cervicofacial infections.
Typical imaging findings of pulmonary parenchymal actinomycosis are chronic segmental air-space consolidations that contain low-attenuation areas with peripheral enhancement and adjacent pleural thickening
Other associated CT findings include hilar or mediastinal lymphadenopathy, bronchiectasis within the consolidation, localized pleural thickening, and pleural effusion.
Further progression of the infection may involve the pleura and chest wall.
At histopathologic correlation, the central low-attenuation area seen on CT represents microabcesss or necrotic material contained within ectatic bronchi. Confirmative diagnosis is based on histopathologic findings of Actinomyces colonies or sulfur granules (yellowish aggregation of clustered mycelia) or filamentous structures within the tissue specimen positive for Grocott-Gomori methenamine
References
Kim TS et al. AJR 2006;186:225-231
Han JY et al. Insights Imaging 2013;4:245-252
Keywords

No. of Applicants : 82

▶ Correct Answer : 29/82,  35.4%
  • - Chonnam National University Hwasun Hospital , Korea (South) KWANGKUN CHO
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - Chonnam National University Hospital , Korea (South) HYUNJIN KIM
  • - , Italy PAOLO BALDASSARI
  • - Chonnam National University Hwasun Hospital , Korea (South) DONGHUN HAN
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - Osaka University , Japan AKINORI HATA
  • - Mie University , Japan HIKARI FUKUI
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Seoul National University Bundang Hospital , Korea (South) JOONHYUK LEE
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Myongji Hospital , Korea (South) HYOUNG YEOB KIM
  • - , Japan SHUNJIRO NOGUCHI
  • - Other , Korea (South) MIN A LEE
  • - Chonnam National University Hospital , Korea (South) GYERYEONG PARK
  • - Chonnam National University Hospital , Korea (South) SOMIN LEE
  • - Samsung Medical Center , Korea (South) YONGJAE KWON
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Other , Korea (South) YONG HO JANG
  • - , Korea (South) JIN WOO YOON
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 14/82,  17.1%
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - The University of Tokyo Hospital , Japan JUN KANZAWA
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Beaulieu clinic Geneva , Switzerland GILLES GENIN
  • - , Japan KENTARO KOTANI
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kyoto University , Japan SHO KOYASU
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - Juntendo University , Japan YUTAKA IKENOUCHI
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