TORAKS DUVARINA İNVAZE BİR PULMONER AKTİNOMİKOZ: OLGU SUNUMU

Pulmoner aktinomikoz tanısı klinik pratikte hala önemli bir sorundur. Otuz yıldır anti diyabetik tedavi kullanan 64 yaşındaki bayan hasta 2 aydır süre gelen öksürük, sol yan ağrısı, ateş yüksekliği yakınmaları ile kliniğimize başvurdu. Akciğer grafisinde sol akciğer alt zonda homojen dansite artışı izlendi. Toraks Bilgisayarlı tomografisinde sol akciğer linguler segment düzeyinde 3 santimetre boyutunda yumuşak doku lezyonu, plevrada kalınla şma saptandı. Fiberoptik bronkoskopik inceleme ve transbronşial biyopsi tanısal değildi. Tanısal amaçlı torakotomi ile hastaya pulmoner aktinomikoz tanısı kondu. Bu yazıda malignite şüphesi olan hastaların ayırıcı tanısında pulmoner aktinomikozun da bulunması gerektiği ve tanıya ulaşmanın zorlukları vurgulanmıştır.

A PULMONARY ACTINOMYCOSIS INVOLVING TO THE CHEST WALL: A CASE REPORT

The diagnosis of pulmonary actinomycosis is still a difficult problem in medical practice. A 64 year old female who had been using antidiyabetic drugs for 30 years was admitted to our hospital with complaints of cough, fever of two months duration. Chest radiography showed a lesion on the left hemithorax. Thorax CT revealed a soft tissue lesion in the left hemithorax of linguler segmentation which was dimension 3 cm and pleural thickness. Fiberoptic bronchoscopic examination and transbronchial biopsy were not diagnostic. The patient was diagnosed as pulmonary actinomycosis after diagnostic thoracotomy. In the present report, we concluded that pulmonary actinomycosis must be kept in mind in the differential diagnosis of the patients with the radiological findings of malignancy and also diffuculty of the diagnosis was emphasized.

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  • 1. Akgün Y. Aktinomikoz ve Nokardiyoz. Topçu AW, Söyletir G, Do¤anay M (ed). ‹nfeksiyon Hastal›klar›. ‹stanbul Nobel T›p Kitabevleri, 1996: 454-455.
  • 2. Jacobs FR, Actinomycosis. In: Behrman RE, Kliegman RM, Jensen HB (eds). Nelson Textbook of Pediatrics. (15th ed). Philadelphia: WB Saunders, 1996: 861-862.
  • 3. Santos JW, Zambenedetti RM, Mann KC, Cibin LF. Thoracic actinomycosis: report of a patient with advanced-stage disease. Braz J Infect Dis 2007; 11: 157-9.
  • 4. Mabeza GF, Macfarlane J. Pulmonary Actinomycosis. Eur Respir J 2003; 21: 545-51.
  • 5. Ljudmila Nagorni-Obradovic, Dragica Pesut, Ruza Stevic and Jelena Stojsic Uncommon pulmonary infection with recurrent hemoptysis. Chinese Medical Journal 2007; 120(24): 2331-3.
  • 6. Russo TA. Agents of Actinomycosis. In: Mandell GL (Ed.), Principles and Practice of Infectious Disease, 5th Ed. Churchill Livingstone, New York.1995; p.2645-2654.
  • 7. Kolditz M, Bickhardt J, Matthiessen W, Holotiuk O, Höffken G, Koschel D. Medical management of pulmonary actinomycosis: data from 49 consecutive cases. J Antimicrob Chemother 2009; 63: 839-41.
  • 8. Weese WC, Smith IM. A study of 57 cases of actinomycosis over a 36-year period. A diagnostic ‘failure’ with good prognosis after treatment. Arch Intern Med 1975; 135: 1562-8.
  • 9. Lerner PI. Actinomyces and Arachnia species. In: Mandell GL, Douglas RG, Bennett JE, eds. Principles and practice ofinfectious diseases. New York: Churchill Livingstone; 1991:1932- 1942.
  • 10. Webb WR, Sagel SS. Actinomycosis involving the chest wall: CT findings. AJR 1982; 139: 1007-9.
  • 11. Cheon JE, Im JG, Kim MY, Lee JS, Choi GM, Yeon KM. Thoracic actonimycosis: CT findings. Radiology 1998; 209: 229-33.
  • 12. Kwong SJ, Muller NL, Godwin JD, Aberle D, Grymalaski M. Thoracic actinomycosis: CT findings in eight patients. Radiology 1992; 183: 189-92.
  • 13. Parker JS, de B oisblanc BP. Case report: Actinomycosis: Multinodular pulmonary involvement. Am J Med Sci 1994; 307: 418-9.
  • 14. Castellucci P, Nanni C, Farsad M, Alinari L, Zinzani P, Stefoni V, Battista G, Valentini D, Pettinato C, Marengo M, Boschi S, Canini R, Baccarani M, Monetti N, Franchi R, Rampin L, Fanti S, Rubello D. Potential pit falls of 18F-FDG PET in a large series of patients treated for malignant lymphoma: prevalence and scan interpretation. Nucl Med Commun 2005; 26: 689-94.
  • 15. Engel H, Steinert H, Buck A, Berthold T, Huch Böni RA, von Schulthess GK. Whole-body PET: physiological and artifactual fluorodeoxyglucose accumulations. J Nucl Med 1996; 37: 441-6.
  • 16. Hoekstra CJ, Hoekstra OS, Teengs JP, Postmus PE, Smit, EF. Thoracic actinomycosis imaging with fluorine-18 fluorodeoxyglucose positron emission tomography. Clin Nucl Med 1999; 24: 529-30.
  • 17. Tokuyasu H, Harada T, Watanabe E, Touge H, Kawasaki Y, Isowa N, Shimizu E. A case of endobronchial actionomycosis evaluated by FDG-PET. Nihon Kokyuki Gakkai Zasshi. 2008; 46(8): 650-4.
  • 18. Ayd›n Y›lmaz, Sezgi fiahin, Çi¤dem Biber, Yurdanur Erdo¤an, Bülent Çiftçi, Ülkü Y›lmaz Turay, P›nar Ergün, Leyla Y›lmaz Ayd›n, Yetkin A¤açk›ran, Sadi Kaya. Epileptik Bir Hastada Maligniteyi Taklit Eden Pulmoner Aktinomikoz. Tur Toraks Der 2009; 10: 151-4.
İzmir Göğüs Hastanesi Dergisi-Cover
  • ISSN: 1300-4115
  • Başlangıç: 1986
  • Yayıncı: Ali Cangül