Bronchopulmonary Actinomycosis Associated With Hiatal Hernia

• Published in: Mayo Clinic proceedings 2009-02, Vol.84 (2), p.123-128
• Main Authors: Andreani, Alessandro, MD, Cavazza, Alberto, MD, Marchioni, Alessandro, MD, Richeldi, Luca, MD, Paci, Massimiliano, MD, Rossi, Giulio, MD
• Format: Article
• Language: English
• Subjects: Actinomycosis; Actinomycosis - complications; Actinomycosis - diagnosis; Actinomycosis - therapy; Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination - therapeutic use; Anti-Bacterial Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Bronchial Diseases - complications; Bronchial Diseases - diagnosis; Bronchial Diseases - therapy; Bronchoscopy; Causes of; Complications and side effects; Cough - microbiology; Diagnosis; Female; Fever - microbiology; Foreign Bodies - microbiology; Foreign Bodies - pathology; General aspects; Hernia, Hiatal - complications; Hiatal hernia; Human bacterial diseases; Humans; Infectious diseases; Internal Medicine; Lung Diseases - complications; Lung Diseases - diagnosis; Lung Diseases - therapy; Male; Medical sciences; Middle Aged; Miscellaneous; Original; Pneumonectomy; Retrospective Studies
• ISSN: 0025-6196; 1942-5546
• DOI: 10.4065/84.2.123

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.