Related Experiment Videos
Tuberculous pulmonary gangrene: report of a case and review
J López-Contreras1, J Ris, P Domingo
1Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Spain.
Abstract:
Pulmonary gangrene is an uncommon but life-threatening complication of bacterial pneumonia. Only four cases of pulmonary gangrene due to Mycobacterium tuberculosis have been described to date; another case of pulmonary gangrene was attributed to unidentified mycobacteria. We report a fetal case of tuberculous pulmonary gangrene (TPG) and review the literature on this infection. To our knowledge this is the first case of TPG documented by thoracic computed tomographic scanning. Radiological features of pulmonary gangrene are distinctive, and identification of pulmonary parenchyma in the mass on computed tomography may be considered as pathognomonic. Analysis of the six cases revealed that most of the patients were aged, and one-half of them were alcohol abusers. Right-upper-lobe involvement predominated. When performed, sputum smears disclosed acid-fast bacilli. M. tuberculosis was cultured from sputum or pathologic material in five of the six cases. Four patients (66.7%) died. Four of six patients with TPG received antituberculous therapy, and two of them survived; no patient underwent surgical intervention. Although surgical management has been successfully employed in cases of bacterial pulmonary gangrene, TPG has always been treated with medical therapy alone. In spite of administration of antituberculous therapy, mortality is high.
Insights
Tuberculous pulmonary gangrene (TPG) is a rare, fatal lung infection. This study presents a unique case, highlighting distinctive CT scan findings and a high mortality rate despite treatment.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Pulmonary gangrene is a severe complication of bacterial pneumonia.
- Tuberculous pulmonary gangrene (TPG) is exceptionally rare, with only a few documented cases attributed to Mycobacterium tuberculosis.
- This report details a unique case of TPG, emphasizing its radiological presentation.
Observation:
- The case presented is the first documented instance of TPG visualized with thoracic computed tomographic (CT) scanning.
- CT imaging revealed distinctive features, including the identification of pulmonary parenchyma within the mass, potentially serving as a pathognomonic sign.
- Analysis of six reported cases indicated a predilection for elderly patients, alcohol abuse, and right-upper-lobe involvement.
Findings:
- Acid-fast bacilli were identified in sputum smears of affected patients.
- Mycobacterium tuberculosis was successfully cultured from sputum or pathological samples in most cases.
- A high mortality rate of 66.7% was observed, even with antituberculous therapy.
Implications:
- Thoracic CT scanning offers distinctive diagnostic features for pulmonary gangrene.
- Despite antituberculous therapy, TPG carries a high mortality rate.
- Current treatment strategies for TPG focus on medical management, with no surgical interventions reported in the reviewed cases.