Esophageal actinomycosis

Esophageal actinomycosis is uncommon and has been reported in immunocompetent and immunocompromised patients. A 41-y-old man with a history of heavy alcohol use presented with progressively worsening odynophagia and dysphagia over a 2-wk period. Upper gastrointestinal endoscopy and esophageal biopsy revealed ulceration withActinomyces and candidal infection. After therapy with intravenous penicillin G followed by oral amoxicillin that led to clinical improvement, repeat upper gastrointestinal endoscopy revealed healing of esophageal ulceration and no evidence ofActinomyces. From this case and a review of the literature regarding clinical symptoms, diagnosis, and treatment, it is clear that esophageal actinomycosis is a cause of odynophagia and dysphagia. Upper gastrointestinal endoscopy and pathologic examination should be carefully evaluated in patients who present with odynophagia and dysphagia.     

Mesenteric actinomycosis

We report a case of abdominal actinomycosis demonstrated on computed tomography (CT) as an isolated mesenteric mass with radiating linear and nodular densities. The lesion mimicked a mesenteric tumor with desmoplastic reaction. The clinical and radiological features of this uncommon entity are reviewed.     

Retroperitoneal actinomycosis

A 44-year-old man had an abscess involving the left psoas muscle and inferior pole of the left kidney associated with characteristic sulfur granules of actinomycosis. The patient was treated with surgical drainage and debridement and with intensive and prolonged penicillin therapy, resulting in a clinical cure and resolution of both the hydronephrosis and the retroperitoneal mass.     

Pelvic actinomycosis.

Pelvic actinomycosis is a rare chronic infection caused by bacteria of the family Actinomycetaceae. Prolonged use of an intrauterine contraceptive device (IUD) is a well known risk factor. We report six patients with pelvic actinomycosis, all of whom had an IUD inserted for over six years. Diagnostic problems necessitated a laparotomy in all patients. The pathohistological diagnosis was based on the characteristic microscopic image and specific staining. The patients were treated with penicillin and amoxycillin for several months.     

Surgical implications of actinomycosis

We have described two patients with abdominal actinomycosis, one with extensive intra-abdominal and thoracic disease mimicking metastatic carcinoma, and the other having the rarely described clinical entity of retroperitoneal disease without evidence of intra-abdominal involvement. Both patients responded well to appropriate therapy, but had unnecessary surgical procedures. The surgeon's role in cases of actinomycosis should be limited to the provision of a diagnosis when necessary.     

胸部放线菌病的影像学特征

目的 观察胸部放线菌的X线平片及CT特征.方法 回顾性分析5例胸部放线菌病患者的影像学资料.结果 5例患者中,3例经支气管纤维镜活检、1例经CT穿刺、1例经手术病理确诊.5例X线正、侧位胸片显示团块和大片密实影,未见空洞、气体和液化灶;CT示病变共累及9个肺叶,26个肺段.4例以团块为主要病灶(其中2例见2个肿块),周围肺见多发斑点、斑片及条索状模糊影;5个团块内均见空洞,薄壁,内壁光滑;空洞内充满低密度液化灶和散在悬浮的气体影,但未见气-液平面,是本组病例较典型的CT表现.5例均见邻近胸膜增厚,4例肺门和(或)纵隔淋巴结增大;1例右肺斑片状影合并纵隔脓肿.结论 以团块内出现空洞为主要表现的胸部放线菌CT表现具有特征性:空洞壁薄、内壁光滑、空洞内充满液化灶和散在悬浮的气体影且不形成气-液平面,可显示病灶的细节征象.X线平片诊断此病价值有限.     

肺放线菌病1例

患者男, 37岁,反复咳嗽、咳痰7个月,为黄色黏痰,午后低热、盗汗,加重伴胸闷2周. 胸片及CT扫描:右肺上叶体积缩小,内见片状多发结节及肿块影,伴多发厚壁空洞,空洞内、外壁光滑、清晰,聚集排列呈簇状. 右肺门上部增大,呈肿块状,右上叶支气管壁增厚,管腔变窄如线样.纵隔内可见少许淋巴结影(图1,2).     

Medical management of visceral actinomycosis

A patient had extensive retroperitoneal actinomycosis with renal and vertebral involvement. Abdominal computed tomography was invaluable in defining the extent of the disease and in assessing the effects of therapy. A cure was accomplished with a prolonged course of oral penicillin and probenecid, and surgical exploration was avoided.     

肺放线菌病1例

患者男，25岁，农民。因间歇性咳嗽，咳痰带血2年，咯血3d入院。2年前患者无明显诱因出现咳嗽、咳痰带血，即前往当地结核病医院求治，经检查诊断为肺结核。给予异烟肼0．3g每日1次，利福平0．6g每日1次，吡嗪酰胺0．5g每日3次口服，链霉素0．75g每日1次肌内注射。治疗2个月效果不佳，后在家不规则治疗，病情时好时坏。3d前突然咯血。咯血量200ml。色鲜红，伴咳嗽，无发烧，胸痛等症状，再次来院就诊。患者既往体健，否认有结核病接触史。入院     

Thoracic actinomycosis with mainly pleural involvement

A 61-year-old man, who had been diagnosed with pleuritis 5 months earlier, was admitted to our hospital to determine if a tumor shadow that appeared in his right lower lung field on March 2002 was a localized pleural mesothelioma. Although a CT-guided lung biopsy was performed, no definite diagnosis was made. However, because the tumor shadow continued to increase in size, we could not rule out the possibility of a malignant thoracic tumor, and performed video-assisted thoracoscopic surgery (VATS). Histological examination of the surgically resected tissue led to a diagnosis of thoracic actinomycosis in the main component of the pleura. Because the recurrence of pulmonary actinomycosis was also suspected after surgical treatment, penicillin G was administered intravenously and afterward amoxicillin was administered intraorally. Subsequently, the patients clinical status improved. We considered a case of thoracic actinomycosis that was suspected to have spread directly from the lung to the chest wall with complicating pleural effusion and remained with organization because there was a pulmonary infiltration shadow in the right upper lobe on chest CT at the first admission.     

Hepatic actinomycosis with portal vein occlusion

Hepatic actinomycosis with abdominal wall invasion was found by computed tomography (CT) in a 44-year-old woman. Occlusion of the main and right portal veins by the actinomycoma causing cavernous transformation was proven by angiography. Duodenobiliary reflux and communication between the biliary tree and the abscess were demonstrated by upper gastrointestinal radiography, percutaneous transhepatic cholangiogram, and CT. The imaging studies reflected the pathologic process of this disease. The unique feature of this case is that infection ascended through the duodenobiliary reflux; this should be considered one of the routes for the transmission of hepatic actinomycosis.