ABSTRACT
Resumen Introducción: El tratamiento de elección del Quiste Hidatídico Pulmonar (QHP) es la resección quirúrgica. Actualmente, existe controversia sobre la superioridad de la cirugía con capitonaje (CC) versus la cirugía sin capitonaje (SC). Objetivo: Comparar los resultados de la cirugía conservadora CC y SC mediante Propensity Score Matching (PSM). Materiales y Método: Se realizó un estudio analítico retrospectivo de los pacientes con QHP tratados quirúrgicamente en el Hospital Guillermo Grant Benavente, Concepción, Chile; entre enero-1995 y diciembre-2018. Se realizó un PSM con una relación 1:1 entre los pacientes operados con la técnica CC y SC. Posterior al PSM se balancearon las características basales. Resultados: Total 205 episodios de QHP en el período. Se realizó cirugía conservadora en 165 casos, 101 CC y 64 SC. Posterior al emparejamiento se obtuvieron 53 pacientes operados CC y 53 SC. No se observaron diferencias significativas en la presencia de fuga aérea persistente (CC = 9,4%; SC = 11,3%, p 0,75), empiema (CC = 3,8%; SC = 0%, p 0,49), días con pleurotomía (CC = 9,1 ± 8,9; SC 10,1 ± 10,7, p 0,39, mediana 6 versus 6 días, respectivamente), ni días de estadía posoperatoria (CC = 10,4 ± 9,0; SC = 11,7 ± 11,9, p 0,22, mediana 7 versus 7 días, respectivamente). Conclusiones: La cirugía SC demostró resultados comparables a la técnica CC en el tratamiento quirúrgico conservador del QHP.
Background: The treatment of choice for Pulmonary Hydatid Cys (PHC) is surgical resection. There is currently controversy about the superiority of surgery with capitonage (SC) versus surgery without it (SWC). Aim: To compare the results of conservative surgery with capitonnage and versus surgery without capitonnage using Propensity Score Matching (PSM). Materials and Method: A retrospective analytical study was carried out with patients with PHC treated surgically at the Guillermo Grant Benavente Hospital, Concepción, Chile, between January-1995 and December-2018. A PSM was performed with a 1:1 ratio. Results: Conservative surgery was done in 165 cases, 101 SC and 64 SWC. After matching, 53 SC and 53 SWC operated patients were obtained. No significant differences were observed in the presence of persistent air leak (9.4% vs11.3%, SC vs SWC respectively, p 0.75), empyema (3.8% vs 0%, p 0.49), days with pleurotomy (9.1 ± 8.9 vs 10.1 ± 10.7, p 0.39), nor days of postoperative stay (10.4 ± 9.0 vs 11.7 ± 11.9, p 0.22). Conclusión: The SWC demonstrated comparable results to the SC technique in the conservative surgical treatment of PHC.
Subject(s)
Humans , Male , Female , Adult , Echinococcosis, Pulmonary/surgery , Echinococcosis, Pulmonary/complications , Echinococcosis, Pulmonary/diagnosis , Parasitic Diseases , Pulmonary Surgical Procedures , Thoracic Surgery , Retrospective Studies , Models, Statistical , Propensity Score , Lung Abscess/diagnosis , Lung Abscess/therapy , Lung DiseasesSubject(s)
Actinomycetales Infections/complications , Actinomycetales Infections/diagnosis , Actinomycetales Infections/microbiology , Bacteremia/diagnosis , Bacteremia/etiology , Bacteremia/microbiology , Child, Preschool , Diagnosis, Differential , Female , Humans , Immunocompetence , Lung Abscess/complications , Lung Abscess/diagnosis , Lung Abscess/microbiology , Radiography, Thoracic , Rhodococcus equi/isolation & purificationABSTRACT
Congenital cystic adenomatoid malformation (CCAM) encompasses a continuum of hamartomatous cystic lung lesions characterised by the presence of abnormal bronchiolar structures of varying sizes or distribution. The CCAM is a disorder of infancy with majority of the cases being diagnosed within the first two years of life. We describe CCAM in a 13-yearold girl complaining of recurrent lower respiratory tract infections since infancy who presented with post-infectious pneumatocele with loculated pleural effusion, and suspected abscess formation and had undergone resection.
Subject(s)
Adolescent , Cystic Adenomatoid Malformation of Lung, Congenital/complications , Cystic Adenomatoid Malformation of Lung, Congenital/diagnosis , Cystic Adenomatoid Malformation of Lung, Congenital/surgery , Diagnosis, Differential , Female , Humans , Lung Abscess/diagnosis , Lung Abscess/etiology , Lung Abscess/surgery , Photomicrography , Pleural Effusion/diagnosis , Pleural Effusion/etiology , Pleural Effusion/surgery , Radiography, Thoracic , Thoracotomy/methods , Tomography, X-Ray ComputedABSTRACT
Congenital cystic adenomatoid lung malformations [CCAM] are, todays, more frequently diagnosed during the pregnancy thanks to progresses in ultrasonographic explorations. On occasion, CCAM may remain asymptomatic and be discovered after being complicated by infection. This was the case of our patient. Amani _ was delivered by spontaneous vaginal delivery at term after a well-controlled pregnancy. She had good staturo-ponderal and psychomotor developments. When she was eight-year-old, she was treated for right pneumonia. Three years later, she was admitted in a general pediatrie unit because of right lower lobe abscess. Thoracic computed tomography, indicated since the infection was recurrent in the same lobe and after the constatation of a persistent cystic feature on chest radiograph, revealed multiple cystic lesions compatible with CCAM. The anatomopathological study of the surgically removed lobe concludes for a cystic adenomatoid lung malformation type I. Cystic adenomatoid lung malformations are frequently revealed by recurrent infections in old children. Thoracic computed tomography is very interesting for the diagnosis when pneumonia relapses in the same site
Subject(s)
Humans , Female , Lung Abscess/diagnosis , Cystic Adenomatoid Malformation of Lung, Congenital/complications , Cystic Adenomatoid Malformation of Lung, Congenital/diagnosis , RecurrenceABSTRACT
OBJETIVO: Apresentar a experiência de um serviço especializado em doenças respiratórias no manejo de casos de abscesso pulmonar de aspiração. MÉTODOS: Descrevem-se aspectos diagnósticos e resultados terapêuticos de 252 casos consecutivos de pacientes com abscesso de pulmão, hospitalizados de 1968 a 2004. RESULTADOS: Dos 252 casos, 209 ocorreram em homens e 43 em mulheres, com média de idade de 41,4 anos. Eram alcoolistas 70,2 por cento dos pacientes. Tosse, expectoração, febre e comprometimento do estado geral ocorreram em mais de 97 por cento dos casos, 64 por cento tinham dor torácica, 30,2 por cento hipocratismo digital, 82,5 por cento apresentavam dentes em mau estado de conservação, 78,6 por cento tiveram episódio de perda de consciência e 67,5 por cento apresentavam odor fétido de secreções broncopulmonares. Em 85,3 por cento dos casos as lesões localizavam-se nos segmentos posterior de lobo superior ou superior de lobo inferior, 96,8 por cento delas unilateralmente. Em 24 pacientes houve associação de empiema pleural (9,5 por cento). Flora mista foi identificada em secreções broncopulmonares ou pleurais em 182 pacientes (72,2 por cento). Todos os doentes foram inicialmente tratados com antibióticos (principalmente penicilina ou clindamicina) e 98,4 por cento deles foram submetidos à drenagem postural. Procedimentos cirúrgicos foram efetuados em 52 (20,6 por cento) pacientes (24 drenagens de empiema, 22 ressecções pulmonares e 6 pneumostomias). Cura foi obtida em 242 pacientes (96,0 por cento) e 10 faleceram (4,0 por cento). CONCLUSÃO: O abscesso pulmonar de aspiração ocorreu predominantemente em indivíduos adultos masculinos com doença dentária e episódio antecedente de perda de consciência (especialmente por alcoolismo). A maioria dos pacientes foi tratada clinicamente (antibióticos e drenagem postural). Um quinto deles submeteu-se a algum procedimento cirúrgico.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Bacterial Infections/diagnosis , Lung Abscess/diagnosis , Pneumonia, Aspiration/diagnosis , Anti-Bacterial Agents/therapeutic use , Bronchoscopy , Bacterial Infections/therapy , Drainage, Postural , Lung Abscess/therapy , Pneumonia, Aspiration/therapy , Retrospective StudiesSubject(s)
Humans , Lung Abscess/surgery , Lung Abscess/diagnosis , Necrosis , Pneumonia , Lung/surgeryABSTRACT
A case of lung abscess due to a rare cause -Actinomycosis is presented. The patient presented with signs and symptoms of pneumonia and failed to respond to antibiotic therapy. CT findings and various modes of treatment are described. CT guided FNAC helped in the final diagnosis where the aspirated material showed several eosinophilic cotton wool colonies of filamentous microorganism consistent with actinomycosis. Due to the thick walled abscess and surrounding unresolved pneumonia the patient was treated with intercostals tube drainage
Subject(s)
Humans , Male , Actinomycosis/diagnosis , Lung Diseases , Lung Abscess/diagnosis , Tomography, X-Ray ComputedABSTRACT
A 48-year-old female patient was diagnosed as a case of allergic bronchopulmonary aspergillosis (ABPA) on the basis of clinical, immunological and radiological criteria. In addition to central bronchiectasis, computed tomography (CT) of the thorax revealed hilar lymphadenopathy and cavitary lesions simulating a lung abscess, a presentation not described earlier. The patient responded to treatment with corticosteroids and the CT repeated after 14 months of treatment showed complete resolution of the cavitary lesions.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Aspergillosis, Allergic Bronchopulmonary/diagnosis , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Lung Abscess/diagnosis , Middle Aged , Radiography, Thoracic/methods , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
El absceso pulmonar (AP) se define como un área de supuración que desarrolla necrosis central y cavitación del parénquima pulmonar, rodeado por una pared gruesa de tejido inflamatorio. Con el objeto de describir las características clínicas, tratamiento y evolución de los pacientes con AP, revisamos los 12 pacientes con AP egresados del Servicio de Pediatría del Hos. Clínico de la U. Católica, durante un período de 10 años (1990 a 1999) cinco pacientes eran hombres; tenían una edad promedio de 4,3 años (5 meses a 8 años); los síntomas principales fueron fiebre, tos, dificultad respiratoria y compromiso del estado general, 7 habían usado antibióticos previo al ingreso. En 10/12 se observó leucocitosis (promedio: 20 136 cel/mmü), aumento de la VHS (promedio: 78 mm/h) y elevación de la PCR (promedio: 31 mg/di). La localización más frecuente fue el LSD (7 casos), LID (2 pacientes), LII (2 casos) y 1 tenía compromiso de LSD y LID. En 7 casos se observó concomitantemente derrame pleural, 4 presentaron atelectasia y 2 neumotórax. Se aisló germen en 4 pacientes, Streptococcus pneumoniae en 3/4 (uno asociado a Stafilococcus aureus) y Streptococcus beta hemolítico grupo A en 1 caso. Todos recibieron tratamiento con 1 o más antibióticos, 2 requirieron lobectomía por alteración anatómica predisponente (secuestro pulmonar o quiste pulmonar simple). La evolución fue hacia la mejoría en todos, con una estadía hospitalaria promedio de 14,8 días y desaparición de las imágenes cavitarias entre la cuarta semana y tercer mes posterior al alta. En nuestro estudio encontramos que el AP es poco frecuente, que tiene una evolución favorable con resolución clínica y radiológica, requiriendo la gran mayoría de las veces solo tratamiento médico
Subject(s)
Humans , Female , Male , Infant , Child, Preschool , Lung Abscess/diagnosis , Pneumonia, Pneumococcal/complications , Clinical Evolution , Leukocytosis/etiology , Lung Abscess/drug therapy , Lung Abscess/etiology , Lung Abscess/surgery , Pneumothorax/etiology , Pleural Effusion/etiology , Pneumonectomy , Pulmonary Atelectasis/etiology , Retrospective Studies , Signs and Symptoms , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/isolation & purification , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/isolation & purificationABSTRACT
La importancia del absceso pulmonar en niños ha disminuido ostensiblemente desde el advenimiento de los antibióticos. A pesar de ello, en grupos especiales de pacientes en un problema relativamente frecuente e importante por sus potenciales complicaciones y secuelas. Los abordajes de la patología en la literatura son infrecuentes y se trata en general de series retrospectivas con datos epidemiológicos incompletos. El tratamiento de elección es terapeútica antibiótica conservadora de larga duración. Las técnicas de aspiración percutáneas mínimamente invasivas han relegado los abordajes quirúrgicos. Sólo la presencia de abscesos grandes y con la inminencia de ruptura y estados toxoinfeciosos severos obligarían a intervenciones invasivas tempranas. El pronóstico global del absceso pulmonar primario es excelente cuando el tratamiento adecuado es instaurado oportunamente
Subject(s)
Humans , Child , Lung Abscess/complications , Lung Abscess/diagnosis , Lung Abscess/etiologyABSTRACT
Although hydatid disease is an uncommon condition in children, yet it needs to be considered in the differential diagnosis of children presenting with homogenous round opacities on chest radiography and hepatomegaly. Six such cases are reported.
Subject(s)
Child , Diagnosis, Differential , Echinococcosis, Hepatic/diagnosis , Echinococcosis, Pulmonary/diagnosis , Female , Humans , Liver/diagnostic imaging , Lung/diagnostic imaging , Lung Abscess/diagnosis , Male , Pleural Effusion/diagnosisABSTRACT
Introducción: El absceso pulmonar es poco frecuente en lactantes y niños; sin embrago, esta unidad es responsable de gran morbimortalidad según lo reporta la bibliografía internacional. Objetivos: Describir la experiencia del Hospital Napoleón Franco Pareja entre 1992 y 1995, en relación con el absceso pulmonar en niños. Pacientes y Métodos: Fueron revisadas de manera retrospectiva 16 historias clínicas de niños con diagnósticos comprobado de absceso pulmonar, quienes fueron hospitalizados y tratados en el Hospital Infantil Napoleón Franco en la Ciudad de Cartagena (Colombia), entre los meses de enero de 1992 y diciembre de 1995. Resultados: Reportamos las características clínicas de la enfermedad, comprendiendo la signo/sintomatología más frecuente, las localizaciones patológicas, sus estudios radiológicos, tratamiento y evolución. Destacamos la presencia de desnutrición severa como un factor condicionante importante del absceso pulmonar (absceso secundario). El tratamiento médico conservador se constituyó en el método único de manejo más utilizado. Sólo un paciente ameritó abordaje quirúrgico abierto (lobectomía). Conclusión: El absceso pulmonar es una patología de alta frecuencia en nuestro medio, lo que se corrobora con la casuística encontrada en nuestra institución (2,37/1.000), que es una de las mayores incidencias reportadas a nivel mundial. El tratamiento antibiótico empírico es útil como único manejo en la mayoría de los casos.
Subject(s)
Humans , Child , Chloramphenicol/therapeutic use , Pneumococcal Infections/classification , Pneumococcal Infections/complications , Pneumococcal Infections/epidemiology , Pneumococcal Infections/drug therapy , Pneumococcal Infections/therapy , Lung Abscess/classification , Lung Abscess/complications , Lung Abscess/diagnosis , Lung Abscess/drug therapy , Lung Abscess/epidemiology , Lung Abscess/etiology , Lung Abscess/pathology , Lung Abscess/physiopathology , Lung Abscess/therapy , Nutrition Disorders/complications , Oxacillin/therapeutic use , Staphylococcus aureus/pathogenicityABSTRACT
This report describes a 28-year-old, HIV-infected man presenting with subacute onset of pyrexia, cough, dyspnoea and pleuritic pain. Chest radiograph showed bilateral multiple cavitary lesions. The diagnosis of salmonellosis was secured by isolation of salmonella typhimurium in blood, as well as in sputum. Therapy with sequential ceftriaxone/ciprofloxacin led to satisfactory improvement symptomatically and radiologically. The present report serves to heighten the awareness of AIDS-associated salmonella bacteremia and lung abscesses.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , Adult , Anti-Bacterial Agents , Bacteremia/diagnosis , Diagnosis, Differential , Drug Therapy, Combination/therapeutic use , Humans , Lung Abscess/diagnosis , Male , Salmonella Infections/diagnosisABSTRACT
Hydatid cysts are common in Turkey. Authors have seen 248 cases of lung hydatid cysts; Fifty hydatid cyst of lung had ruptured. Their symptoms and detailed findings are reported. Rupture caused asphyxia in 3, haemoptysis in 20, lung abcess in 16, rupture in pleural cavity in 4 and anaphylactic reaction in one case.
Subject(s)
Echinococcosis, Pulmonary/complications , Emergencies , Female , Humans , Lung Abscess/diagnosis , Male , Middle Aged , Pneumonectomy , Pulmonary Fibrosis/diagnosis , Rupture, SpontaneousABSTRACT
A male patient presented with complaints of fever, cough with expectoration, burning micturition and 5-6 semisolid motions per day for the past 6 days. Skiagram chest (PA view) revealed lung abscess in the left mid zone. There was no improvement, symptomatically and radiologically, after an empirical course of antibiotics (IV ampicillin and gentamycin). Sputum, urine and stool cultures grew salmonella group E organisms sensitive only to cefotaxime. The patient was treated with IV cefotaxime and responded well clinically, radiologically and bacteriologically.