title: Surgical therapy for necrotizing pneumonia and lung gangrene.
abstract: OBJECTIVE
  Necrotizing pneumonia, pulmonary abscess, and lung gangrene are rare complications of severe pulmonary infection with devitalization and sloughing of lung tissue. Pulmonary necrosis is often associated with alcoholism and other chronic disorders with known immunodeficiency. Mortality is significant and both treatment strategies as well as the role of surgery are controversially debated.
  
  
  METHODS
  In a retrospective review at a German tertiary referral hospital, 20 patients with pulmonary resection for necrotizing lung disorders were identified since 2008. At hospital admission, all patients suffered from pulmonary sepsis and despite adequate medical treatment progressing parenchymal destruction and devitalization took place. The majority of the patients sustained pleural empyema (13/20) and five patients a persisting air leak. On account of failing medical therapy, eight patients (40%) developed severe sepsis with septic shock and four patients (20%) were already preoperatively ventilated. Chronic alcoholism was present in 10 patients (50%).
  
  
  RESULTS
  Gangrene of a complete lung was seen in four cases. Lobar gangrene or necrotizing pneumonia complicated by fulminate abscess was seen in the right lower lobe (8/20), middle lobe (4/20), right upper lobe (2/20), and left lower lobe (2/20). Procedures included pneumectomy (4/20), lobectomy (13/20), and limited resection (3/20). The bronchial stump was reinforced with a pedicle muscle flap in seven cases. There were three postoperative deaths due to septic shock with multiorgan failure. The remaining 17 patients (85%) recovered well and were transferred to rehabilitation clinics specialized on pulmonary disorders.
  
  
  CONCLUSIONS
  Necrotizing pulmonary infections are infrequent but are life-threatening disease entities. Patients often present with severe comorbidity and chronic disorders causing immunodeficiency. If initial medical therapy fails surgery offers a reasonable therapeutic approach. Aim of surgical therapy is resection of all gangrenous lung parenchyma and effective drainage of pleural empyema. Then recovery is feasible in up to 80%.
authors.affiliation: Department of General and Thoracic Surgery, Klinikum Nuernberg Nord, Nuernberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schweigert
authors.forename: Attila
authors.initials: A
authors.lastname: Dubecz
authors.forename: Martin
authors.initials: M
authors.lastname: Beron
authors.forename: Dietmar
authors.initials: D
authors.lastname: Ofner
authors.forename: Hubert J
authors.initials: HJ
authors.lastname: Stein
mesh_terms: D000437:Alcoholism / Q000150:complications; D001999:Bronchoscopy; D016724:Empyema, Pleural / Q000209:etiology / Q000601:surgery; D005260:Female; D005734:Gangrene; D005858:Germany; D006801:Humans; D008168:Lung / Q000473:pathology / Q000601:surgery*; D008169:Lung Abscess / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D009336:Necrosis; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011014:Pneumonia / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011030:Pneumothorax / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000601:surgery; D013524:Surgical Flaps / Q000009:adverse effects; D062606:Tertiary Care Centers; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome