Mahler D A, D'Esopo N D
Clin Chest Med. 1981 Jan;2(1):51-7.
The difficulty in classifying pulmonary infection within areas of bullous emphysema may have contributed to the lack of appreciation of this entity. This process is important to recognize because: (1) the clinical picture is usually benign:; (2) it may be confused with tuberculosis, fungal disease, and carcinoma of the lung; and (3) radiographic resolution may be slow. For these reasons, pneumonitis which occurs within emphysematous lung may have been previously considered as slowly resolving pneumonias. The development of air-fluid levels within bullae has been called "infected emphysematous bullae." We believe that this phrase is misleading since there are no bacteriologic data to support the presence of infection within the bullae containing fluid. In fact, direct sampling of intrabullous fluid has been rarely reported and, if obtained, has been generally negative for bacteria. Furthermore, the clinical course in our patients is alos not consistent with infection within a space. Once fiberoptic bronchoscopy has excluded an obstructing endobronchial lesion, the physician may patiently follow the anticipated gradual resolution. We suggest that the phrase, "periemphysematous lung infection" best describes these related clinical-radiological conditions.
在大疱性肺气肿区域内对肺部感染进行分类存在困难，这可能导致了对该实体认识不足。认识这个过程很重要，原因如下：（1）临床表现通常较为良性；（2）它可能与肺结核、真菌病和肺癌相混淆；（3）影像学上的消退可能较慢。出于这些原因，发生在肺气肿肺内的肺炎以前可能被认为是缓慢消退的肺炎。大疱内出现气液平面被称为“感染性肺气肿大疱”。我们认为这个术语具有误导性，因为没有细菌学数据支持含有液体的大疱内存在感染。事实上，对大疱内液体进行直接采样的报道很少，即便采样，结果通常也未发现细菌。此外，我们患者的临床病程也与一个腔隙内的感染情况不符。一旦纤维支气管镜检查排除了阻塞性支气管内病变，医生可以耐心等待预期的逐渐消退。我们建议，“肺气肿周围肺部感染”这一术语最能描述这些相关的临床 - 放射学情况。
