Elsevier

Mayo Clinic Proceedings

Volume 84, Issue 2, February 2009, Pages 123-128
Mayo Clinic Proceedings

ORIGINAL ARTICLE
Bronchopulmonary Actinomycosis Associated With Hiatal Hernia

https://doi.org/10.4065/84.2.123Get rights and content

OBJECTIVES

To describe clinicoradiologic and histopathologic features of bronchopulmonary actinomycosis and to determine whether hiatal hernia (HH) is a potential predisposing factor for bronchopulmonary actinomycosis.

PATIENTS AND METHODS

We reviewed the medical charts of 10 patients who had bronchopulmonary actinomycosis between November 1, 2002, and January 31, 2008. Complete clinical data, radiologic studies (chest radiographs and computed tomographic scans), and histopathologic features were assessed to investigate clinical manifestations and predisposing factors related to bronchopulmonary actinomycosis.

RESULTS

The series consisted of 6 men and 4 women, with a mean age of 63.5 years; 8 of the patients were smokers. Cough and fever were the most common symptoms. Chest imaging showed mass-like consolidation in 4 patients, bronchial thickening or lung atelectasis with pleural thickening in 2 patients each, and perihilar irregular mass or multiple bilateral nodules in 1 patient each. Primary or metastatic lung cancer was suspected clinically in 8 of the 10 patients. Foreign body-related endobronchial actinomycosis was diagnosed in 6 patients, 5 of whom had HH; only 1 had gastroesophageal reflux-related symptoms. Because of bronchial obstruction, rigid bronchoscopy was performed in 3 patients, lobectomy in 2, and atypical resection in 1. Antibiotic therapy with amoxicillin was given to all patients, with resolution of actinomycosis.

CONCLUSION

Bronchopulmonary actinomycosis is a rare condition that mimics pulmonary malignancy on clinical and radiologic grounds. Diagnosis relies on an accurate patient history and histopathologic examination. Although further confirmation is required, esophageal HH appears to be a potential predisposing factor.

Section snippets

PATIENTS AND METHODS

Clinical records, imaging studies, and histopathologic biopsy reports of 10 patients with bronchopulmonary actinomycosis were analyzed from the database of the Hospital Azienda Policlinico of Modena (8 patients) and the Hospital St Maria Nuova of Reggio Emilia (2 patients) between November 1, 2002, and January 31, 2008. The collected data include complete medical history, radiologic findings (including chest computed tomography [CT]), treatments, and histopathologic and histochemical findings

Clinical and Radiographic Findings

The age at diagnosis of the 6 men and 4 women ranged from 41 to 83 years (mean ± SD age, 63.5±12.5 years; median, 67.0 years). Of these 10 patients, 8 had a history of smoking: 6 were current smokers, and 2 were ex-smokers (defined as quitting >3 years before diagnosis). Presenting symptoms were cough (8 patients), fever (5 patients), dyspnea (2 patients), and gastroesophageal reflux disease (GERD; 1 patient) (Table).

Six patients had esophageal HH (Figure 1), but only 1 patient had symptoms

DISCUSSION

Bronchopulmonary actinomycosis is a chronic suppurative infectious disease with a protean spectrum of clinical and radiologic presentations. This disease mainly simulates primary or metastatic malignancies and other more common pulmonary infections.3, 4, 5, 6, 7, 8 Thus, the diagnosis can be challenging and is often delayed, with a mean of 6 months from symptom onset; less than 10% of cases are suspected by clinicians.3 Universally accepted predisposing factors for bronchopulmonary

CONCLUSION

Bronchopulmonary actinomycosis is a rare and often unexpected disease that is basically detected only at histologic examination. Most important, HH seems to represent a hitherto unreported potential predisposing condition for bronchopulmonary actinomycosis. This association based on a limited number of cases could simply be due to chance alone and clearly needs further confirmatory studies.

Acknowledgments

This work is dedicated to the memory of our friend and pneumologist colleague Alberto Fontana, MD.

REFERENCES (19)

There are more references available in the full text version of this article.

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