Yang Por-Wen, Lin Hong-Da, Wang Lee-Min
Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan, ROC.
J Chin Med Assoc. 2008 Sep;71(9):442-7. doi: 10.1016/S1726-4901(08)70146-1.
Septic pulmonary embolism (SPE) is one of the metastatic foci of pyogenic liver abscess. The purpose of this study was to investigate the clinical presentations of, and management options for patients with pyogenic liver abscess complicated with SPE.
A retrospective chart review was conducted from January 1, 1999 to December 31, 2005 inclusively, in a medical center in northern Taiwan. We collected and analyzed the clinical presentations, diagnostic modalities, treatment programs and prognoses for all pyogenic liver abscess patients with SPE.
The association between liver abscess affected with the complication of SPE and diabetes mellitus was significant. There were 9 patients who had pyogenic liver abscess with SPE. Abnormal chest radiograph (CXR) findings with multiple ill-defined peripheral round densities were noted in all patients. Seven patients were diabetic, fever occurred in 5 patients, respiratory symptoms were noted in 6 patients, and abdominal pain occurred in 3 patients. Endophthalmitis coexisted in 3 patients, meningitis in 1 patient, and necrotizing fasciitis in 2 patients. Microbiological studies revealed Klebsiella pneumoniae in 9 patients. Computed tomography (CT) demonstrated metastatic nodules in both lung lobes, some of which featured cavitation, in all 9 patients. Three patients soon advanced to acute respiratory failure, and later died due to acute respiratory distress syndrome and/or septic shock. The remaining 6 patients survived without complication during their hospital course.
There is diagnostic value in performing a chest CT scan in diabetic patients who have liver abscess plus abnormal CXR findings with multiple ill-defined peripheral round densities, in order to detect SPE, which has a relatively poor outcome in patients with liver abscess.
脓毒性肺栓塞（SPE）是化脓性肝脓肿的转移病灶之一。本研究旨在探讨化脓性肝脓肿合并SPE患者的临床表现及治疗方案。
回顾性分析1999年1月1日至2005年12月31日期间台湾北部某医疗中心所有化脓性肝脓肿合并SPE患者的病历。收集并分析患者的临床表现、诊断方法、治疗方案及预后情况。
肝脓肿合并SPE与糖尿病之间的关联具有显著性。共有9例化脓性肝脓肿合并SPE患者。所有患者胸部X线（CXR）检查均发现多个边界不清的外周圆形密度影异常。7例患者患有糖尿病，5例发热，6例有呼吸道症状，3例有腹痛。3例患者合并眼内炎，1例合并脑膜炎，2例合并坏死性筋膜炎。微生物学研究显示9例患者感染肺炎克雷伯菌。计算机断层扫描（CT）显示所有9例患者双肺叶均有转移结节，部分结节有空洞形成。3例患者很快进展为急性呼吸衰竭，随后因急性呼吸窘迫综合征和/或感染性休克死亡。其余6例患者在住院期间无并发症存活。
对于患有肝脓肿且胸部X线检查有多个边界不清的外周圆形密度影异常的糖尿病患者，进行胸部CT扫描以检测SPE具有诊断价值，SPE在肝脓肿患者中预后相对较差。
