Rakotoson J L, Rakotoharivelo H, Andrianasolo R, Palot A, Gouitaa M, Charpin D
Service de pneumologie-allergologie de l'hôpital Nord, AP-HM, chemin des Bourrelys, Marseille cedex 20, France.
Rev Pneumol Clin. 2011 Apr;67(2):105-8. doi: 10.1016/j.pneumo.2010.05.002. Epub 2010 Dec 3.
Organizing pneumonia secondary to a hiatal hernia is a specific kind of inflammatory and fibroproliferative lung reaction due to a pulmonary aggression involving micro-inhalation of the digestive contents. The authors report the case of a 74-year-old woman presenting pneumonia of infectious speed, resistant to a triple antibiotic treatment. Clinically, her general condition changed and associated cough, fever, dirty sputum and dyspnoea. The bacteriological and immunological tests were normal. The respiratory functional explorations showed a moderate restrictive syndrome and hypoxemia. The broncho-alveolar wash found a mixed alveolite of predominantly lymphocyte and polynuclear neutrophiles. The thoracic scanner detected pleural alveolar opaqueness with the characteristic of organizing pneumonia as well as a voluminous hiatal hernia discovered by chance. No lung samples were taken because of a precarious general state of the patient and the respiratory instability. The strong corticosensitivity to the corticosteroid therapy backed up the authors' diagnostic hypothesis. The clinical and radiological evolution was good after six months of treatment. The patient benefited from a medical and then surgical treatment with a good evolution and without any recurrence.
继发于食管裂孔疝的机化性肺炎是一种特殊类型的炎症性和纤维增生性肺反应，由涉及消化道内容物微吸入的肺部侵袭引起。作者报告了一例74岁女性病例，该患者出现快速进展的感染性肺炎，对三联抗生素治疗耐药。临床上，她的一般状况发生变化，并伴有咳嗽、发热、脓痰和呼吸困难。细菌学和免疫学检查均正常。呼吸功能检查显示中度限制性综合征和低氧血症。支气管肺泡灌洗发现以淋巴细胞和多形核中性粒细胞为主的混合性肺泡炎。胸部扫描仪检测到具有机化性肺炎特征的胸膜肺泡混浊以及偶然发现的巨大食管裂孔疝。由于患者一般状况不稳定且呼吸功能不稳定，未采集肺组织样本。对皮质类固醇治疗的高度敏感性支持了作者的诊断假设。治疗六个月后，临床和影像学进展良好。患者接受了药物治疗，随后接受手术治疗，病情进展良好，无任何复发。
