A CASE OF PULMONARY ACTINOMYCOSIS SUBJECTED TO RESECTION OF THE PHRENIC NERVE

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  • KATSURA Hiroshi
    Department of Respiratory Surgery, Osaka Prefectural Organization Medical Center for Respiratory and Allergic Diseases
  • NAKAGAWA Katsuhiro
    Department of Respiratory Surgery, Osaka Prefectural Organization Medical Center for Respiratory and Allergic Diseases
  • NAKANE Shigeru
    Department of Respiratory Surgery, Osaka Prefectural Organization Medical Center for Respiratory and Allergic Diseases

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  • 横隔神経合併切除を要した肺放線菌症の１例

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Abstract

A 60-year-old man was referred to us for a detailed evaluation of a pulmonary nodule associated with bloody sputum. He had been taking antibiotics under the diagnosis of organizing pneumonitis confirmed by transbronchial lung biopsy. Although the pulmonary nodule had markedly decreased in size, the patient intermittently showed reduced bloody sputum. But surgery for differential diagnosis and control symptoms was postponed by the patient himself for a few months.<br> Afterwards thoracotomy was performed to control a refractory massive hemoptysis. Left upper segmentectomy including resection of the phrenic nerve was needed because of rigid adhesions between the mediastinal pleura and the phrenic nerve adjacent to the pulmonary mass. The postoperative pathological diagnosis revealed pulmonary actinomycosis, although the frozen section histopathological findings indicated lymphoma. He was treated with oral antibiotics for three months after definitive diagnosis. In patients with pneumonitis showing air space consolidation and recurrent bloody sputum, it is important to consider the possibility of pulmonary actinomycosis for the differential diagnosis and to confirm the diagnosis as early as possible to avoid extended resections.

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