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2016 ; 23
(ä): 182-5
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Empyema necessitans caused by actinomycosis: A case report
#MMPMID27180228
Atay S
; Banki F
; Floyd C
Int J Surg Case Rep
2016[]; 23
(ä): 182-5
PMID27180228
show ga
INTRODUCTION: Pulmonary actinomycosis is an uncommon clinical entity that the
practicing thoracic surgeon rarely encounters. Empyema necessitans represents an
even less common presentation of this pathology, and the often indolent disease
course leads to early misdiagnosis in many cases. Familiarity with the varied
presentations and possible operative strategies is essential to obtaining
successful outcomes. PRESENTATION OF CASE: A 56-year-old male presented with
swelling and pain over the lateral chest wall. Initial imaging studies
demonstrated a mass concerning for infection vs. neoplasia. Further studies were
obtained to confirm the diagnosis, with rapid progression of the mass. Surgical
exploration with aggressive debridement of the chest wall without thoracotomy was
performed. Actinomyces was identified on final pathology, confirming the
diagnosis of Actinomycosis empyema necessitans. DISCUSSION: Traditional
management strategies often involve pulmonary resection in addition to extended
duration antimicrobial therapy. This report describes the uncommon clinical
presentation and successful management of actinomycosis empyema necessitans with
early limited operative intervention. CONCLUSION: In the event of minimal
pulmonary involvement and absence of lung abscess, as was seen in this case, a
thoracotomy with pulmonary resection can be avoided, and antibiotic duration
limited.