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Abstract:
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.
Insights
Pulmonary infection in bullous emphysema is often misdiagnosed due to its benign presentation and slow radiographic resolution. The study suggests "periemphysematous lung infection" as a more accurate term than "infected emphysematous bullae."
Area of Science:
- Pulmonology
- Radiology
- Infectious Diseases
Background:
- Pulmonary infections in bullous emphysema present diagnostic challenges.
- Misclassification can lead to confusion with tuberculosis, fungal diseases, and lung cancer.
- Radiographic resolution of these conditions is often slow, mimicking resolving pneumonias.
Purpose of the Study:
- To clarify the classification and terminology of pulmonary infections occurring in the context of bullous emphysema.
- To differentiate these conditions from true bacterial infections within emphysematous bullae.
- To propose a more accurate descriptive phrase for these clinical-radiological findings.
Main Methods:
- Review of clinical presentations and radiographic findings in patients with pulmonary conditions in emphysematous lungs.
- Exclusion of endobronchial lesions via fiberoptic bronchoscopy.
- Analysis of available bacteriologic data from intrabullous fluid sampling (where reported).
Main Results:
- The clinical picture is typically benign, with slow radiographic resolution.
- Bacteriologic data supporting infection within bullae containing fluid is generally absent or negative.
- The phrase "infected emphysematous bullae" is considered misleading due to lack of evidence for bacterial infection.
Conclusions:
- Pulmonary conditions in bullous emphysema are often misidentified.
- The term "periemphysematous lung infection" is proposed as a more fitting description.
- Physicians should consider gradual resolution after excluding endobronchial obstruction.