RESUMO
A patient initially treated with corticosteroids for cryptogenic organising pneumonia following pulmonary infarction, developed a worsening condition with progressive cavitary formations in both lower lung lobes. Contrast-enhanced chest computed tomography revealed a pulmonary embolism, and serum anti-Aspergillus IgG antibody analysis yielded a strong positive result. Consequently, the patient was diagnosed with pulmonary infarction with Aspergillus infection; organising pneumonia in surrounding areas reflected the repair process. Following treatment with anticoagulants and antifungal agents, the patient was successfully discharged. Hence, pulmonary infarction should be considered in cases of refractory lung lesions. LEARNING POINTS: Pulmonary infarction should be considered in case of refractory lung lesions, even if the patient does not have the risk of embolism.Organising pneumonia should be assessed carefully because it may occur as a repair process of various lung diseases.
RESUMO
Children and older adults are prone to unintentional foreign body aspiration. A 69-year-old man with fever and anorexia presented with obstructive pneumonia resulting from foreign body aspiration. Attempts to remove the foreign body using a bronchoscope failed due to its adhesion to the periphery of the bronchus. Although antibiotic therapy did not improve the obstructive pneumonia caused by the bronchial foreign body, surgery enabled an improvement. The surgical specimen showed similar pathological findings as the fine brown granular material observed in root granulomas occurring as a complication following leakage of root canal filling used in the treatment of dental caries. Therefore, the bronchial foreign body may have been a dental filling. Case reports describing surgical improvement of difficult-to-remove bronchial foreign bodies with concurrent infection are rare.
RESUMO
Empyema and complicated para-pneumonic effusion (CPPE) often require surgical intervention because of insufficient antibiotic effect and chest tube drainage. From January 2017 to September 2021, we encountered seven patients who underwent intrapleural urokinase injection after medical thoracoscopy for the treatment of empyema or CPPE. None of the seven patients required further surgical interventions or showed any complications associated with the therapeutic procedures. The combined use of intrapleural urokinase injections and medical thoracoscopy may be an effective and safe therapeutic option for the management of empyema and CPPE.
