Department of Respiratory Medicine, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi-shi, Mie, 510-0822, Japan.
Department of Orthopaedic Surgery, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi-shi, Mie, 510-0822, Japan.
J Med Case Rep. 2022 Jul 1;16(1):255. doi: 10.1186/s13256-022-03481-w.
Pulmonary actinomycosis is a chronic disease characterized by abscess formation, draining sinuses, fistulae, and tissue fibrosis. It can mimic other conditions, particularly malignant and granulomatous diseases, and is perhaps extremely challenging to diagnose.
A 64-year-old Japanese man presented with 6-week history of a painful solid lump in the chest wall. Chest computed tomography scan revealed a mass-like consolidation in the left upper lobe, with rib erosion and direct extension into the anterior chest wall. F-fluorodeoxyglucose positron emission tomography scan showed increased metabolic activity in the mass, which is indicative of primary lung cancer. The bronchoscopy and computed tomography scan-guided transthoracic biopsy results were considered nondiagnostic. Finally, the patient was diagnosed with pulmonary actinomycosis via surgical resection. He completed an 8-week course of antibiotic therapy and experienced no recurrence.
There is no difference in positron emission tomography/computed tomography scan findings between actinomycosis and malignancy. Therefore, pulmonary actinomycosis should be considered in the differential diagnosis of cases involving intensive activity on F-fluorodeoxyglucose positron emission tomography scan.
肺放线菌病是一种以脓肿形成、窦道、瘘管和组织纤维化为特征的慢性疾病。它可以模仿其他疾病，特别是恶性和肉芽肿性疾病，因此诊断极具挑战性。
一名 64 岁的日本男性因胸痛性肿块就诊，病史 6 周。胸部计算机断层扫描显示左上叶肿块样实变，伴有肋骨侵蚀和直接向前胸壁延伸。氟代脱氧葡萄糖正电子发射断层扫描显示肿块代谢活性增加，提示原发性肺癌。支气管镜和计算机断层扫描引导下经胸活检结果考虑为非诊断性。最终，通过手术切除确诊为肺放线菌病。他接受了 8 周的抗生素治疗，没有复发。
放线菌病和恶性肿瘤的正电子发射断层扫描/计算机断层扫描结果没有差异。因此，在氟代脱氧葡萄糖正电子发射断层扫描显示高代谢活动的病例中，应考虑肺放线菌病的鉴别诊断。
