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Systemic-to-pulmonary artery fistula following actinomycosis
Abstract:
We report a case of pleuropulmonary actinomycosis in a child followed by a most unusual complication: the appearance of a systemic-to-pulmonary artery fistula in the area where the abscess was drained. Fifteen months after successful treatment with penicillin and surgical drainage, a continuous murmur was heard over the scar. Aortic angiography showed multiple connections between the intercostal arteries and the left pulmonary artery through an angiomatous lesion in the left lower lobe. This resulted in a considerable left-to-right shunt. Possible pathogenic mechanisms are discussed.
Insights
A child with pleuropulmonary actinomycosis developed a rare systemic-to-pulmonary artery fistula after abscess drainage. This unusual complication, identified via angiography, highlights potential long-term risks following infection treatment.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Pleuropulmonary actinomycosis is a rare bacterial infection affecting the lungs and pleura.
- Surgical drainage is a common treatment for actinomycotic abscesses.
- Systemic-to-pulmonary artery fistulas are uncommon vascular complications.
Observation:
- A child treated for pleuropulmonary actinomycosis developed a continuous murmur post-drainage.
- Aortic angiography revealed an angiomatous lesion connecting intercostal arteries to the left pulmonary artery.
- This resulted in a significant left-to-right shunt in the pulmonary circulation.
Findings:
- The case presents an unusual complication of pleuropulmonary actinomycosis treatment.
- The fistula formation occurred in the region of previous abscess drainage.
- Angiomatous changes and arterial connections suggest a novel pathogenic pathway.
Implications:
- This case underscores the importance of vigilant monitoring for rare vascular complications after thoracic infections.
- Understanding the pathogenesis of such fistulas may inform future treatment strategies.
- Further research into the mechanisms of acquired vascular anomalies post-infection is warranted.