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Pulmonary gangrene: radiological and pathologic correlation
C A Curry1, E K Fishman, J A Buckley
1Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Abstract:
Although frequently referred to as pulmonary abscess or necrotizing pneumonia, pulmonary gangrene is a distinct entity, requiring prompt medical and often surgical management. Radiographically, it begins as a lobar consolidation, usually in the upper lobes, develops lucencies, and coalesces to form a cavity. A "mass within a mass" or air crescent sign may be present. A vasculitis ensues, devitalizing parenchyma that must be drained surgically or expectorated through a patent bronchus. Serious complications of pulmonary gangrene that often lead to death are detected on computed tomography (CT) before these changes are apparent on chest radiographs. Specifically, a narrowed or obliterated bronchus impedes drainage of necrotic parenchyma and thrombosis of large vessels prevents the delivery of antimicrobial therapy. We review the literature and report this case to show the importance of CT in the early detection and management of pulmonary gangrene.
Insights
Pulmonary gangrene, a distinct lung condition, requires prompt medical and surgical care. Computed tomography (CT) is crucial for early detection of complications, improving patient outcomes.
Area of Science:
- Pulmonary Medicine
- Radiology
- Thoracic Surgery
Background:
- Pulmonary gangrene is often misdiagnosed as pulmonary abscess or necrotizing pneumonia.
- It necessitates urgent medical and surgical intervention.
Observation:
- Radiographic findings include lobar consolidation, lucencies, cavity formation, and potential "mass within a mass" or air crescent signs.
- Vasculitis leads to parenchymal devitalization requiring drainage.
- Computed tomography (CT) reveals serious complications like bronchial obstruction and vascular thrombosis before they are visible on standard radiographs.
Findings:
- CT is vital for identifying bronchial narrowing or obliteration, which hinders necrotic tissue drainage.
- CT also detects thrombosis of large vessels, impeding antimicrobial therapy delivery.
- Early CT detection facilitates timely management of pulmonary gangrene.
Implications:
- Prompt diagnosis and management of pulmonary gangrene, guided by CT, can prevent life-threatening complications.
- Understanding the distinct features of pulmonary gangrene and its complications is essential for effective treatment.
- CT imaging plays a pivotal role in the early detection and surgical or medical management of this severe lung condition.