RESUMEN
We report an unusual presentation of pulmonary embolism (PE) where a 58-year-old man first developed symptoms of community-acquired pneumonia. Despite antibiotic therapy, he remained unwell with rising inflammatory markers, general malaise and persistent cough. He developed stony dull percussion and absent breath sounds to his left mid to lower zones. Serial chest x-rays showed progression from lobar consolidation to a large loculated left-sided pleural collection. CT chest showed left-sided lung abscess, empyema and bronchopleural fistulation. Incidentally, the scan revealed acute left-sided PE and its distribution corresponded with the location of the left lung abscess and empyema. The sequence of events likely started with PE leading to infarction, cavitation, abscess formation and bronchopleural fistulation. This patient was managed with a 6-month course of rivaroxaban. After completing 2 weeks of intravenous meropenem, he was converted to 4-week course of oral co-amoxiclav and metronidazole and attained full recovery.
Asunto(s)
Absceso/diagnóstico por imagen , Antibacterianos/uso terapéutico , Fístula Bronquial/diagnóstico por imagen , Infarto/diagnóstico por imagen , Enfermedades Pleurales/diagnóstico por imagen , Neumonía/tratamiento farmacológico , Embolia Pulmonar/diagnóstico por imagen , Radiografía Torácica , Absceso/tratamiento farmacológico , Absceso/patología , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Fístula Bronquial/tratamiento farmacológico , Fístula Bronquial/fisiopatología , Progresión de la Enfermedad , Quimioterapia Combinada , Humanos , Infarto/tratamiento farmacológico , Infarto/fisiopatología , Masculino , Meropenem , Metronidazol/uso terapéutico , Persona de Mediana Edad , Enfermedades Pleurales/tratamiento farmacológico , Enfermedades Pleurales/fisiopatología , Neumonía/diagnóstico por imagen , Neumonía/fisiopatología , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/fisiopatología , Rivaroxabán/uso terapéutico , Tienamicinas/uso terapéutico , Resultado del TratamientoRESUMEN
In the pleural empyema (PE) treatment, not depending on introduction of multiple operative procedures and the medicinal preparations application, some issues remain unsolved, including the infection agents verification, the most rapid bronchial fistula elimination and the lung volume restoration. The EP infection agents spectrum, their sensitivity to preparations were revealed, as well as the enhanced rate of the methicillin-resistant stamms (MRSA) and the microorganisms associations verification. A reduction of the infection agents sensitivity towards "simple" antibacterial preparations was established, so the physicians, treating PE, must prescribe "hard" antibiotics, what enhances its cost.