Yoshitomi A, Chida K, Suda T, Kuwata H, Todate A, Tsukamoto K, Nakamura H, Takahashi T, Suzuki K
Second Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
Nihon Kokyuki Gakkai Zasshi. 1999 Aug;37(8):619-22.
A 62-year-old man with a medical history that included artificial pneumothorax therapy at the age of 18 was admitted to our hospital because of persistent cough. Chest computed tomographic scans disclosed atelectasis in the right lung and pyothorax surrounded by calcifications. Radiographic examination failed to disclose any tumors. After admission, high grade fever developed due to aggravated pyothorax infection. Because antibiotic therapy and drainage failed, open window thoracostomy was performed. Tumors were found along the wall of the pyothorax cavity, and examination of resected specimens yielded a diagnosis of non-Hodgkin's lymphoma, diffuse large cell type (B-cell lineage). It was difficult to close the pyothorax cavity due to infection and lymphoma. Therefore, with the thoracic window open, the patient was given combination chemotherapy including CHOP (6 courses) and DeVIC (7 courses). He died of disseminated intravascular coagulation 17 months after thoracostomy. In patients with pyothorax associated lymphoma, chemotherapy is sometimes difficult to perform because of persistent pyothorax infection. Although edema and ascites due to protein loss from the tumor complicated the treatment of our patient, we concluded that open window thoracostomy is effective in managing pyothorax prior to and during chemotherapy.
一名62岁男性因持续咳嗽入院，其病史包括18岁时接受过人工气胸治疗。胸部计算机断层扫描显示右肺肺不张及被钙化灶包围的脓胸。影像学检查未发现任何肿瘤。入院后，因脓胸感染加重出现高热。由于抗生素治疗和引流均失败，遂行胸廓开窗造口术。在脓胸腔壁发现肿瘤，对切除标本的检查确诊为非霍奇金淋巴瘤，弥漫大细胞型（B细胞系）。由于感染和淋巴瘤，难以闭合脓胸腔。因此，在胸廓开窗的情况下，给予患者包括CHOP（6个疗程）和DeVIC（7个疗程）的联合化疗。胸廓开窗造口术后17个月，患者死于弥散性血管内凝血。对于脓胸相关性淋巴瘤患者，有时由于持续性脓胸感染而难以进行化疗。尽管肿瘤蛋白丢失导致的水肿和腹水使我们这位患者的治疗复杂化，但我们得出结论，胸廓开窗造口术在化疗前及化疗期间处理脓胸方面是有效的。
