- 期刊
Pulmonary Actinomycosis Presenting as a Lung Mass Crossing the Fissure-A Case Report
以穿越肺裂之腫塊為表徵的肺部放射線菌病－病例報告
摘要
放射線菌病是少見的肺部細菌感染，其臨床與影像學表現多不具特異性，常被延遲診斷或誤認為腫瘤、結核病或肺炎。本病例為59歲男性病人，臨床表現為長期且反覆性的咳血，胸部X光及電腦斷層掃描發現一左上肺葉腫塊，穿越大肺裂，並侵入到左下肺葉。腫塊之電腦斷層導引切片僅顯示有急慢性發炎現象，因此先給予短期經驗性抗生素治療，但咳血及病灶仍然持續，所以進行外科手術切除，病理切片發現肺膿瘍及硫顆粒放射線菌，因此診斷為肺部放射線菌病，經有效抗生素長期治療後痊癒，後續追蹤並未復發。回顧文獻，在影像學上發現肺部有橫跨肺裂之病灶時，除了考慮腫瘤、肺結核、諾卡菌病或真菌感染之外，需進一步檢查是否有放射線菌感染，以利儘早治療。
並列摘要
Pulmonary actinomycosis, a rare bacterial lung infection, usually presents with nonspecific clinical symptoms and radiological patterns and is prone to being a delayed diagnosis or misdiagnosed as malignancy, tuberculosis, or pneumonia. We report a 59-year-old man who suffered from chronic, repeated hemoptysis. The chest radiograph and CT image revealed a left upper lung mass that extended across the major fissure into the left lower lobe. A CT-guided biopsy of the lung mass was done and revealed acute and chronic inflammation. The hemoptysis symptom and the lung lesion persisted despite short courses of empirical antibiotic treatment. Therefore, surgical resection was performed and the pathology showed a lung abscess with ”sulfur granules”, a finding pathognomonic of actinomycosis. The patient received amoxicillin/clavulanate for 8 months with complete relief of symptoms and no recurrence of lung infiltrates. This case report reminds us that, in addition to malignancy, tuberculosis, nocardiosis and fungal infection, actinomycosis should be included in the differential diagnosis of a lung lesion crossing the fissure, in order to provide prompt diagnosis and treatment.
延伸閱讀
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