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[胸段放线菌病:3例]

[Thoracic actinomycosis: three cases].

作者信息

Herrak L, Msougar Y, Ouadnouni Y, Bouchikh M, Benosmane A

机构信息

Service de Chirurgie Thoracique, CHU Ibn Sina, Rabat, Maroc.

出版信息

Rev Pneumol Clin. 2007 Sep;63(4):268-72. doi: 10.1016/s0761-8417(07)92651-6.

Abstract

Actinomycosis is a rare condition which, in the thoracic localisation, can mimic cancer or tuberculosis. We report a series of three case of thoracic actinomycosis treated in the Ibn Sina University Thoracic Surgery Unit in Rabat, Morocco. CASE N degrees 1: This 45-year-old patient presented a tumefaction on the left anterior aspect of the chest. Physical examination identified a parietal mass with fistulisation to the skin. Radiography demonstrated a left pulmonary mass. Transparietal puncture led to the pathological diagnosis of actinomycosis. The patient was given medical treatment and improved clinically and radiographically. CASE N degrees 2: This 68-year-old patient presented repeated episodes of hemoptysis. The chest x-ray revealed atelectasia of the middle lobe and bronchial fibroscopy demonstrated the presence of a bud in the middle lobar bronchus. Biopsies were negative. The patient underwent surgery and the histology examination of the operative specimen revealed pulmonary actinomycosis. The patient recovered well clinically and radiographically with antibiotic therapy. CASE N degrees 3: This 56-year-old patient presented cough and hemoptysis. Physical examination revealed a left condensation and destruction of the left lung was noted on the chest x-ray. Left pleuropulmonectomy was performed. Histological analysis of the surgical specimen identified associated Aspergillus and Actinomyces. The outcome was favorable with medical treatment. The purpose of this work was to recall the radiological, clinical, histological, therapeutic, outcome aspects of this condition and to relate the problems of differential diagnosis when can suggest other diseases.

摘要

放线菌病是一种罕见疾病,在胸部发病时可类似癌症或肺结核。我们报告了在摩洛哥拉巴特的伊本·西那大学胸外科治疗的3例胸部放线菌病病例。病例1:该45岁患者胸部左前侧出现肿块。体格检查发现一个壁层肿块并与皮肤形成瘘管。影像学检查显示左肺有肿块。经壁穿刺导致放线菌病的病理诊断。患者接受药物治疗,临床和影像学表现均有改善。病例2:该68岁患者反复咯血。胸部X线显示中叶肺不张,支气管纤维镜检查显示中叶支气管有一个小结节。活检结果为阴性。患者接受了手术,手术标本的组织学检查显示为肺放线菌病。患者经抗生素治疗后临床和影像学恢复良好。病例3:该56岁患者出现咳嗽和咯血。体格检查发现左肺实变,胸部X线显示左肺有破坏。实施了左胸膜肺切除术。手术标本的组织学分析发现合并曲霉菌和放线菌。药物治疗后预后良好。这项工作的目的是回顾这种疾病的放射学、临床、组织学、治疗及预后方面,并阐述提示其他疾病时的鉴别诊断问题。

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