RESUMO
Klebsiella pneumoniae has been reported to be the most common pathogen causing pyogenic liver abscess. K. pneumoniae liver abscess occurs fairly often in patients with diabetes mellitus, and is commonly associated with metastatic infections such as brain abscess, endophthalmitis, lung abscess, osteomyelitis, prostatitis, necrotizing fasciitis and infection in other sites. Although septic pulmonary embolism (SPE) is uncommon, it is a serious metastatic complication of K. pneumoniae liver abscess. Chest computed tomography (CT) scans are crucial in making the early diagnosis of SPE; however, it does not provide the basis for a definitive diagnosis. A 70-year-old man was referred to the Department of Pulmonology due to cough and an abnormal chest radiography. The chest CT scans revealed relatively well-demarcated, round multiple nodules with peripheral preponderance, cavitary mass in the right upper lobe of the lung and low-density hepatic cystic masses. Bronchoscopic examination and percutaneous needle aspiration of the lung were performed, but there was no evidence of malignancy. Finally, K. pneumoniae was grown from a bronchial washing specimen and blood culture. Intravenous carbapenem was administered over a 3-week period and follow-up CT scans showed improvement in both the lung and the liver. We report a case of K. pneumoniae liver abscess complicated with SPE requiring differential diagnosis of hematogenous metastatic malignancy on CT scans in an elderly patient.
Assuntos
Idoso , Humanos , Abscesso Encefálico , Tosse , Diabetes Mellitus , Diagnóstico , Diagnóstico Diferencial , Diagnóstico Precoce , Endoftalmite , Fasciite Necrosante , Seguimentos , Klebsiella pneumoniae , Klebsiella , Abscesso Hepático , Abscesso Hepático Piogênico , Fígado , Pulmão , Abscesso Pulmonar , Agulhas , Osteomielite , Pneumonia , Prostatite , Embolia Pulmonar , Pneumologia , Radiografia , Tórax , Tomografia Computadorizada por Raios XRESUMO
Although most of the patients with endobronchial tuberculosis have some degree of bronchial stenosis, more aggressive treatment is needed to restore the patency of the involved tracheobronchial tree for some patients not responding well to antituberculous chemotherapy combined with steroids. In our first case, we resected stenotic trachea in a 42 years old women who showed overgrowing granulation tissue through the modified Gianturco stent wire which was previously inserted and anastomosed end to end. Another case was a 37 years old male with left main bronchial restenosis complicated after inserting a Strecker stent and sleeve left upper lobectomy was performed.
Assuntos
Adulto , Feminino , Humanos , Masculino , Constrição Patológica , Tratamento Farmacológico , Tecido de Granulação , Stents , Esteroides , Traqueia , TuberculoseRESUMO
Although most of the patients with endobronchial tuberculosis have some degree of bronchial stenosis, more aggressive treatment is needed to restore the patency of the involved tracheobronchial tree for some patients not responding well to antituberculous chemotherapy combined with steroids. In our first case, we resected stenotic trachea in a 42 years old women who showed overgrowing granulation tissue through the modified Gianturco stent wire which was previously inserted and anastomosed end to end. Another case was a 37 years old male with left main bronchial restenosis complicated after inserting a Strecker stent and sleeve left upper lobectomy was performed.