대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Lab

Pleural effusion analysis: Polymorphonuclear leukocytes dominant exudate
Culture (-), Fungus culture (-), AFB (-)
Leukocytosis and CRP (9.6 mg/dl)

Chief Complaint

Dyspnea, general weakness

Past History

DM, COPD

Reviewy

Nocardia
- Aerobic Gram-positive bacilli of with branching filament.
- Weakly acid fast
Common natural inhabitants of the soil
Rare among normal population, most infections occurring in immuno-compromised hosts.
Structural lung disease, pulmonary alveolar proteinosis (PAP), diabetes mellitus is also known risk factors.

Radiographic manifestations are pleomorphic
- Multifocal lung consolidation, nodules and masses
: Abscess formation, Cavitation (~1/3)
- Pleural Involvement
: Loculated pleural effusion and pleural thickening
- Chest Wall Extension, resulting empyema necessitatis

Differential diagnosis
Tuberculosis
- Mediastinal and hilar lymphadenopathy is not a usual feature of pulmonary nocardiosis
Actinomycosis
- Usually develops in patients with poor dentition
- Immunocompromised condition does not appear to be a risk factor of actinomycosis
Septic lung
Vasculitis
Malignancy

Keywords