Hammond J M, Lyddell C, Potgieter P D, Odell J
Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.
Chest. 1993 Nov;104(5):1610-2. doi: 10.1378/chest.104.5.1610.
Massive pulmonary gangrene is a rare complication of pneumonia, particularly in the postantibiotic era. We report two cases of community-acquired Streptococcus pneumoniae pneumonia in young patients with a background of heavy alcohol abuse, but no other preexisting disease, which failed to respond to appropriate antibiotic therapy and intensive care. In both, there was extensive unilateral involvement, with initial dense consolidation followed by cavitation, but the previously reported classic later radiologic feature of coalescence into a large cavity with free-floating slough was not seen. Owing to ongoing sepsis with the development of multiple organ failure and the obvious failure of appropriate medical therapy, both patients underwent pneumonectomy with a successful outcome. These cases serve to emphasize the role of surgery in the management of massive pulmonary gangrene.
大面积肺坏疽是肺炎的一种罕见并发症，尤其是在抗生素时代之后。我们报告了两例社区获得性肺炎链球菌肺炎病例，患者均为年轻男性，有重度酗酒史，但无其他基础疾病，对适当的抗生素治疗和重症监护无反应。两者均有广泛的单侧受累，最初为致密实变，随后出现空洞形成，但未见到先前报道的典型后期影像学特征，即融合成一个带有自由漂浮坏死组织的大空洞。由于持续的脓毒症伴多器官功能衰竭的发展以及适当药物治疗明显失败，两名患者均接受了肺切除术，结果成功。这些病例有助于强调手术在大面积肺坏疽治疗中的作用。
