title: [Pulmonary actinomycosis with "balls-in-a hole" appearance diagnosed by examination of bronchial lavage fluid].
abstract: A 49-year-old man was referred to our hospital because of abnormal chest X-ray findings. Chest X-ray films showed infiltrative opacities in the right lung, and histological findings of a transbronchial biopsy specimen showed non-specific inflammation. The patient was treated with Ofloxacin for one month. After the treatment, chest X-ray films showed that the infiltrative opacities in the right upper lobe had decreased, but that opacities in the right lower lobe had increased, with an air meniscus sign. A chest computed tomography scan at the same time revealed that the remaining opacities contained multiple mass-like lesions within a cavity in the right S6, appearing as "balls in a hole". One year after the first visit, the patient visited the hospital again because of cough and sputum. A chest X-ray film showed that the size of the cavity in the right lower lobe had increased. The histological findings from a fresh transbronchial biopsy specimen revealed a non-specific inflammation again; however, black clots obtained from bronchial lavage fluid after biopsy were histologically identified as sulfur granules, a classic pathological indication of actinomycosis. This confirmed the diagnosis of pulmonary actinomycosis. The patient was treated with penicillin, and the opacities in the right lower lobe subsided.
authors.affiliation: Department of Respiratory Disease, Yokohama Rosai Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Morikawa
authors.forename: K
authors.initials: K
authors.lastname: Takeuchi
authors.forename: Y
authors.initials: Y
authors.lastname: Tanaka
authors.forename: H
authors.initials: H
authors.lastname: Furuiye
authors.forename: M
authors.initials: M
authors.lastname: Fukumura
authors.forename: R
authors.initials: R
authors.lastname: Mikami
authors.forename: T
authors.initials: T
authors.lastname: Yamagata
authors.forename: Y
authors.initials: Y
authors.lastname: Kakuta
authors.forename: S
authors.initials: S
authors.lastname: Kawamura
authors.forename: Y
authors.initials: Y
authors.lastname: Tashiro
mesh_terms: D000196:Actinomycosis / Q000000981:diagnostic imaging* / Q000382:microbiology*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic