title: Pulmonary infections imitating lung cancer: clinical presentation and therapeutical approach.
abstract: BACKGROUND
  Pulmonary infections occasionally present with infectious pseudotumour of the lung not easily distinguishable from true pulmonary neoplasm. In such cases, radiographic findings and clinical manifestation are highly suggestive of lung cancer. These inflammatory lung lesions cause significant diagnostic problems and appropriate therapy is often considerably delayed. We therefore report on our experience with infectious pseudotumour of the lung caused by bacterial, mycobacterial and fungal pulmonary infections.
  
  
  METHODS
  In a retrospective case series, patients with lung infections simulating pulmonary carcinoma were identified. Clinical presentation, radiological features, surgical procedures and outcome were analysed.
  
  
  RESULTS
  There were seven male and six female patients with a mean age of 53 years. Presumed pulmonary carcinoma and hemoptysis were main reasons for hospital admission. Procedures performed were video-assisted thoracoscopic wedge resection (6), lobectomy (5), video-assisted thoracoscopic lobectomy and open wedge resection each in one case. Pathologic examination of the obtained specimens revealed tuberculoma (5), aspergilloma (3), pulmonary actinomycosis related pseudotumour (3) and coccidioidoma (2). Following definite diagnosis, patients with tuberculosis and fungal infections received antituberculotic and antifungal medications, respectively. Patients suffering from pulmonary actinomycosis received penicillin. There was no in-hospital mortality. One re-thoracotomy was mandatory because of pleural empyema.
  
  
  CONCLUSIONS
  Pulmonary infections simulating lung cancer require surgical removal both for establishing definite diagnosis and to manage complications like haemoptysis and ongoing contamination of the airways by infectious agents. Whenever feasible, limited thoracoscopic resections are preferable. Following definite diagnosis antimicrobial drug therapy for a sufficient length of time is mandatory.
authors.affiliation: Department of General and Thoracic Surgery, Klinikum Nürnberg Nord, Nürnberg, Germany. michael.schweigert@klinikum-nuernberg.de
authors.forename: M
authors.initials: M
authors.lastname: Schweigert
authors.forename: A
authors.initials: A
authors.lastname: Dubecz
authors.forename: M
authors.initials: M
authors.lastname: Beron
authors.forename: D
authors.initials: D
authors.lastname: Ofner
authors.forename: H J
authors.initials: HJ
authors.lastname: Stein
mesh_terms: D000196:Actinomycosis / Q000000981:diagnostic imaging / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003047:Coccidioidomycosis / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging / Q000628:therapy; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000000981:diagnostic imaging / Q000628:therapy; D011859:Radiography; D012189:Retrospective Studies; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000628:therapy; D055815:Young Adult