Misdiagnosis or missed diagnosis? Thoracic actinomycosis and carcinoma on sequential CT-guided lung biopsies.

Biópsia aspirativa transtorácica por agulha fina guiada por TC de lesões pulmonares: resultados e complicações

“…(5,19) The relevant lesion-related risk factors for pneumothorax are the distance between the lesion and the chest wall and the small size of the lesion, which increase the degree of difficulty of the procedure. (3)(4)(5)10,15) In the present study, severe COPD (FEV 1 < 1.0 L) and the distance between the lesion and the chest wall were not considered absolute contraindications for the procedure. Three cases required immediate chest tube drainage due to rapid clinical decompensation in patients with severe COPD.…”

“…(7) In the present study, the accuracy of the procedure in establishing a diagnosis of malignant lesion was 91.5%, and the rate of false-positive results was 17.6% (3 cases), all cytological findings being suggestive of, but not confirming the atelectasis-free lung parenchyma as possible, thus reducing the risk of pneumothorax. (3)(4)(5)(6) The effect that the results of CT-guided fineneedle aspiration biopsy of pulmonary lesions have on the clinical management of patients varies from case to case. The major useful aspects of the procedure include its accuracy in diagnosing malignant lesions, its ability to establish cancer subtypes efficiently, its ability to establish specific benign diagnoses, and, consequently, its ability to reduce the need for surgery (thoracotomy or video-assisted thoracic surgery) for the analysis of cases.…”

“…The principal patient-related risk factors are severe pulmonary emphysema and COPD, which contribute to an increase in the incidence of pneumothorax and to the need for chest tube drainage after pneumothorax has been detected. (3)(4)(5)19) Two groups of authors have established a direct relationship between the severity of COPD (as measured by FEV 1 during spirometry) and an increased risk of developing pneumothorax, together with a need for chest tube drainage. (5,19) The relevant lesion-related risk factors for pneumothorax are the distance between the lesion and the chest wall and the small size of the lesion, which increase the degree of difficulty of the procedure.…”

Actinomycose pulmonaire disséminée avec atteinte hépatique : une forme trompeuse mimant un tableau polymétastatique

“…Des lésions osseuses lytiques peuvent exister même si elles sont rarement décrites dans la littérature [10]. Les lésions radiologiques pouvant évo-quer un cancer du poumon sont non spécifiques, et beaucoup d'autre pathologies non néoplasiques, telles que les infections pulmonaires, les infarctus et les abcès, peuvent avoir des représentations similaires [11,12]. En plus de la lésion pseudotumorale, notre malade présentait des opacités nodulaires multiples et bilatérales en lâcher du ballon associées à une localisation viscérale hépatique réalisant ainsi la forme pulmonaire généralisée pseudo tumorale.…”

“…Mais une association tuberculose-actinomycose ou cancer-actinomycose a été décrite [14][15][16]. Des cas d'actinomycose endobronchique induit par un corps étranger imitant un carcinome bronchique et des cas de culture positive d'actinomycose sur des masses parenchymateuses de cancer bronchique ont égale-ment été décrits [1,12,17,18]. L'antibiotique de référence est la Pénicilline G parentérale (10 à 20 millions d'UI/jour), durant deux à six semaines, relayée par la voie orale (Amoxicilline, deux à quatre grammes par jour) pendant trois à 12 mois [2,19].…”