Surgical considerations for pulmonary actinomycosis.
BACKGROUND
Diagnosis and treatment of pulmonary actinomycosis is difficult without surgical intervention.


METHODS
Thirteen patients (10 men, 3 women; mean age, 62 years) underwent pulmonary resection and were given a pathologic diagnosis of pulmonary actinomycosis at our institution between 1976 and 2001. To clarify when pulmonary actinomycosis should be suspected in patients and the role of surgical intervention, we reviewed preoperative clinical characteristics, computed tomography findings, surgical indication, operative procedure, postoperative clinical course, and outcome.


RESULTS
Ten patients (77%) had poor oral hygiene. Twelve patients (92%) were symptomatic, and 10 patients (77%) had hemoptysis. The mean interval between radiographic identification of the abnormality and surgical intervention was 8 months (interquartile range, 3.25 to 8 months). Computed tomography findings in all cases included radiologic opacity with air bronchogram or a low attenuation area. Lung cancer was diagnosed initially because of computed tomography findings of spiculation or pleural indentation, and operation was required in 8 patients (62%). The others were diagnosed with chronic pneumonia, and surgical intervention became necessary because of recurrent hemoptysis or prolonged illness. Six patients underwent lobectomy; the others underwent partial resection or segmentectomy. Neither complication nor recurrence has occurred.


CONCLUSIONS
When patients, particularly those with poor oral hygiene, show radiologic opacity with an air bronchogram or low attenuation area on the computed tomography scan, pulmonary actinomycosis should be considered and penicillin should be administered as diagnostic therapy. Surgical intervention may be necessary when frequent hemoptysis has no resolution or lung neoplasm cannot be ruled out.
Department of Surgery, Jichi Medical School, Kawachi-gun, Tochigi, Japan. tcvshun@jichi.ac.jp
Shunsuke
S
Endo
Fumio
F
Murayama
Tsutomu
T
Yamaguchi
Shin-ichi
S
Yamamoto
Shin-ichi
S
Otani
Noriko
N
Saito
Yasunori
Y
Sohara
D000196:Actinomycosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed