Gangrene Of Lung Research Articles

Lethal case of lung gangrene against the background of viral-bacterial pneumonia (COVID-19 and <i>Fusobacteria</i>)

The respiratory system is the main target of COVID-19 infection spread by the SARS-CoV-2 virus. This study presents a case of viral–bacterial pneumonia caused by SARS-CoV-2 and Fusobacteria complicated by the development of gangrene in the lower lobe of the right lung with abscess formation. Accompanied by an ambulance team for emergency reasons, the patient was admitted for inpatient treatment with complaints of pain when coughing, dyspnea, cough with mucopurulent sputum, and fever up to 39.6°С. Chest computed tomography revealed signs of viral–bacterial pneumonia. Infiltration was determined in the lower lobe of the right lung, against which a cavity with melting lung tissue was observed. A virological test of throat and nasal swabs detected SARS-CoV-2 coronavirus RNA. Despite treatment, the patient died. Autopsy revealed signs of viral–bacterial pneumonia, a decaying cavity with purulent content, and diffuse destructive changes with hemorrhages. The cause of death of the patient was COVID-19, which caused bilateral viral–bacterial pneumonia complicated by the development of gangrene in the lower lobe of the right lung with abscess formation.

Survival with optimal medical management in a cohort of severe necrotizing bacterial lung infections.

Necrotizing pneumonia and lung gangrene represent a continuum of severe lung infection. Traditionally, severe cases have been referred for surgical debridement. However, this has been linked to high mortality. Some groups have published encouraging results using a conservative medical approach. Unfortunately, lack of a standardized definition of necrotizing pneumonia has precluded meaningful comparison between medical and surgical approach in severe cases. Our objective was to describe the outcome of a cohort of severe necrotizing pneumonia treated with optimal medical management. We conducted an observational retrospective study by reviewing charts and radiology records of patients hospitalized between 2006-2019 in a tertiary center. We included all patients with severe necrotizing infection, defined as a necrotizing cavity involving at least 50% of a lobe, or smaller multilobar cavities. We made no distinction between necrotizing pneumonia and gangrene as there are no standardized criteria. A total of 50 consecutive patients were included. On imaging, 42% had multilobar cavities and mean diameter of the largest cavity in each case was 5.9 cm. 50% required mechanical ventilation (median duration 12 days) and 44% needed vasopressors. Four patients (8%) had decortication surgery, while none underwent lung resection. Four patients (8%) died. The extent of infiltrates and number of cavities were not associated with mortality but the extent of infiltrates was associated with risk of intubation (P=0.004). We presented one of the largest series of medically-treated severe necrotizing lung infections in the pre-coronavirus disease-2019 (COVID-19) era. The overwhelming majority of patients recovered with optimal medical management alone. Our results strongly support avoiding pulmonary resection in patients with severe necrotizing bacterial lung infections.

Surgical approach for destructive pneumonia associated with COVID-19

There were over 400 million people with COVID-19 pneumonia worldwide and over 12 million in the Russian Federation after 2020. Complicated course of pneumonia with abscesses and gangrene of lungs was observed in 4% of cases. Mortality ranges from 8 to 30%. We report 4 patients with destructive pneumonia following SARS-CoV-2 infection. In one patient, bilateral lung abscesses regressed under conservative treatment. Three patients with bronchopleural fistula underwent staged surgical treatment. Reconstructive surgery included thoracoplasty with muscle flaps. There were no postoperative complications that required redo surgical treatment. We observed no recurrences of purulent-septic process and mortality.

Benign tumors of the large bronchi and trachea

The OBJECTIVE was to assess the incidence, diagnostic abilities and surgical tactics in case of benign tumors of the large bronchi and trachea.METHODS AND MATERIALS. Benign tumors of the large bronchi and trachea were diagnosed in 29 (6.3 %) of patients among 445 patients with benign bronco-pulmonary tumors. The diagnosis was made due to X-ray and endoscopic studies. Lung resections were performed in 5 (17.2 %) patients. RESULTS. Clinical symptoms were non-specific. In 10 (35.7 %) cases, the disease was diagnosed during X-ray examination. Computed tomography revealed pulmonary changes caused by bronchial narrowing in 5 patients (17.2 %).The biopsy taken during bronchoscopy detected the histological form of the tumor in 16 (55 %) patients. The exact morphological type of the tumor was identified after its removal. More often, they were polyps (48.3 %), papillomatosis (20.7 %), chondromas (10.3 %), in single cases – teratomas, sclerosing hemangioma, adenoma, mucoepidermoid tumor, histiocytoma, inflammatory pseudotumors. In 24 (82.8 %) patients, tumors were removed during bronchoscopy by electrosurgical or argonoplasmic destruction methods. The repeated surgery for a recurrence was required in 5 (17.2 %) patients in terms of (8.3±4.7) months, three times for two patients. In three cases, we performed lobectomy; in one case, we performed lobectomy with wedge resection of the intermediate bronchus. Pneumonectomy was made in two patients: one patient suspected of cancer after tumor biopsy, the other – complicated with lung gangrene. The latter patient died of pneumonia of the single lung. The mortality rate was 3.4 %.CONCLUSION. In presence of non-specific pulmonary symptoms resistant to therapy, it is necessary to rule out benign bronchial tumors using X-ray and endoscopy. Most formations can be removed during bronchoscopy. In case of irreversible lung changes or impossible endoscopic removal, we should use surgery.

P5‐85: Staged treatment of middle lobe lung gangrene using the vacuum‐assisted closure therapy in a patient with severe COVID‐19 pneumonia

P5‐85: Staged treatment of middle lobe lung gangrene using the vacuum‐assisted closure therapy in a patient with severe COVID‐19 pneumonia

АНГИОПУЛЬМОНОГРАФИЯ С НИТРОГЛИЦЕРИНОВЫМ ТЕСТОМ В ДИАГНОСТИКЕ ОСТРЫХ ИНФЕКЦИОННЫХ ДЕСТРУКЦИЙ ЛЕГКИХ

Objective. To develop a method for additional and differential diagnosis of acute infectious lung destruction (AILD) based on angiopulmonography with the nitroglycerin test. Methods. Angiopulmonography with the nitroglycerin test was used in 10 patients with suppurative diseasesof thelung and pleura for additional and differential diagnosis of AILD The method was used in such situations when chest computed tomography did not allow to determine unambiguously the presence and / or prevalence of necrosis of the lung parenchyma. Results. In 3 patients with the lung abscess, a clear restriction of the decay cavity was registered with the preservation of the main blood flow and weakening of the parenchymal phase of the blood circulation along the periphery of the destructive area. During the nitroglycerin test performance there was no change in the filling of the microvascular bed with contrast along the periphery of the decay cavity, which made it possible to determine the presence of parietal sequesters. According to the results of the study, the lung gangrene was diagnosed in 6 patients. At the same time, two variants of circulatory disorders were noted: the first - with preservation of the blood flow through the main vessels and with the absence of a parenchymal phase in the lesion focus, the second - with the violation of the main blood flow. In the affected area no change in blood flow was observed after the nitroglycerin test performance. Similar results of the study indicated the development of necrosis of the pulmonary parenchyma, which was subsequently confirmed during the operations performed. In the site of inflammatory infiltration of the pulmonary parenchyma with preserved main blood flow, the depletion of the parenchymal phase of blood circulation was determined, but after the nitroglycerin test, a pronounced enrichment of the vascular architecture to the parenchymal phase in the pneumonia affecting part of the lung was noted. Conclusion. It has been established that AILD is characterized by irreversible changes in the vascular bed of the lung parenchyma in the lesion focus. Angiopulmonography with the nitroglycerin test is considered to be an additional highly informative method improving the early and differential diagnosis of AILD in difficult clinical situations. What this paper adds It has been found out that during angiopulmonography the areas of pulmonary necrosis are characterized by the absence of a vascular pattern with or without disturbance of the blood flow through the segmental arteries. At the same time, in contrast to the foci of pneumonia, the nitroglycerin test is not accompanied by an evaluation of the filling of the pulmonary vascular bed in the affected area, i.e. blood supply disorders are irreversible. Thus, based on an assessment of the nature and reversibility of the blood flow disturbances in the affected lung, it is possible to carry out differential diagnosis of the early stages of acute infectious lung destruction (AILD) and pneumonia.

Lung and mediastinum abscesses in Poland: a national hospital register-based study.

Airway infections represent one of the most common causes of mortality worldwide. The authors sought to describe patients hospitalized for lung and mediastinum abscesses in Poland from 2009 to 2016. To the authors' knowledge, this is the first evaluation of the disease in Poland. The authors conducted a retrospective, population-based study, using data from 14,932 hospital discharge records. Lung and mediastinum abscesses incidence rates were estimated on the basis of data from a Polish hospital morbidity study, carried out by the National Institute of Public Health. The study group consisted of 12,049 patients (74.3% male and 25.7% female patients) hospitalized for the first time with the diagnosis of lung or mediastinum abscesses. The mean and median age was 57.2 and 59 years, respectively. The mean age was significantly higher in females than males (57.9 years vs. 57 years, p < 0.05). Patients were hospitalized with the following diagnosis: abscess of lung with pneumonia (60.9%), abscess of lung without pneumonia (24.9%), abscess of lung and mediastinum (2.6%), gangrene and necrosis of lung (2.8%), abscess of mediastinum (9.7%). The average annual incidence of lung abscesses, including gangrene or necrosis of lung, was 35.7 per million (95% CI: 34.1-37.4) and the average annual incidence of mediastinum abscess was 4.8 per million (95% CI: 4.3-5.3). The incidence rates for all cases of lung or mediastinum abscesses did not vary significantly between urban and rural regions. Presented recent data on lung and mediastinum abscesses in Poland may be helpful in comparative analyses among European countries.

Абсцесс и гангрена легкого: эволюция методов лечения

Абсцесс и гангрена легкого: эволюция методов лечения

Arsenic disturbs the gut microbiome of individuals in a disadvantaged community in Nepal

Arsenic is ubiquitous in nature, highly toxic, and is particularly abundant in Southern Asia. While many studies have focused on areas like Bangladesh and West Bengal, India, disadvantaged regions within Nepal have also suffered from arsenic contamination levels, with wells and other water sources possessing arsenic contamination over the recommended WHO and EPA limit of 10 μg/L, some wells reporting levels as high as 500 μg/L. Despite the region's pronounced arsenic concentrations within community water sources, few investigations have been conducted to understand the impact of arsenic contamination on host gut microbiota health. This study aims to examine differential arsenic exposure on the gut microbiome structure within two disadvantaged communities in southern Nepal. Fecal samples (n = 42) were collected from members of the Mahuawa (n = 20) and Ghanashyampur (n = 22) communities in southern Nepal. The 16S rRNA gene was amplified from fecal samples using Illumina-tag PCR and subject to high-throughput sequencing to generate the bacterial community structure of each sample. Bioinformatics analysis and multivariate statistics were conducted to identify if specific fecal bacterial assemblages and predicted functions were correlated with urine arsenic concentration. Our results revealed unique assemblages of arsenic volatilizing and pathogenic bacteria positively correlated with increased arsenic concentration in individuals within the two respective communities. Additionally, we observed that commensal gut bacteria negatively correlated with increased arsenic concentration in the two respective communities. Our study has revealed that arsenic poses a broader human health risk than was previously known. It is influential in shaping the gut microbiome through its enrichment of arsenic volatilizing and pathogenic bacteria and subsequent depletion of gut commensals. This aspect of arsenic has the potential to debilitate healthy humans by contributing to disorders like heart and liver cancers and diabetes, and it has already been shown to contribute to serious diseases and disorders, including skin lesions, gangrene and several types of skin, renal, lung, and liver cancers in disadvantaged areas of the world like Nepal.

Thrombectomy and Lung Resection for Massive Left Pulmonary Embolism in a 30 Years Old Man in Yaounde, Cameroon

Pulmonary embolism is a well-recognized clinical entity with significant morbidity and mortality. It is called massive when it extends over more than half of the vascular bed. In the past, surgical treatment was the last therapeutic option but more and more surgical treatments are performed in several centers with few side effects and a lower mortality rate. Pulmonary embolectomy has never been attempted in Cameroon. We are reporting herein the first case of massive pulmonary embolism in a 30 years old man complicated by lung gangrene treated by thrombectomy and lung resection.

Emergent pneumonectomy for lung gangrene – does the outcome warrant the procedure?

Emergent pneumonectomy for lung gangrene – does the outcome warrant the procedure?

Emergent Pneumonectomy for Lung Gangrene: Does the Outcome Warrant the Procedure?

Sloughing and gangrene of a complete lung are only very infrequently encountered complications of necrotizing pneumonia and fulminant pulmonary abscess formation. Thus far the role of emergent pneumonectomy is not established. The outcome of patients who underwent anatomic lung resection for lung gangrene at 3 centers for thoracic surgery during the last 13 years was retrospectively analyzed. Only cases of necrotizing pneumonia were included whereas malignant lesions were excluded. Overall 44 patients were indentified (average age 56.3 years). Pulmonary sepsis (27 of 44), pleural empyema (29 of 44), persistent air leakage (14 of 44), and respiratory failure with mechanical ventilation (14 of 44) were present preoperatively. The mean Charlson comorbidity index was 2.77. Procedures were segmentectomy (7), lobectomy (26), and pneumonectomy (11). In-hospital mortality was 7 of 44; 2 following pneumonectomy and 5 after lobectomy. In comparing the pneumonectomy group with the lobectomy group we found no significant differences in age (p=0.59), Charlson comorbidity index (p=0.18), and postoperative mortality (p=1). Charlson comorbidity index 3 or greater (odds ratio [OR], 8.41; 95% confidence interval [CI], 0.88 to 421.71; p=0.04), preoperative pleural empyema (OR, 3.56; 95% CI, 0.37 to 179.62; p=0.39) and preoperative persistent air leak (OR, 7.34; 95% CI, 1.00 to 89.98; p=0.02) were associated with higher risk for fatal outcome. Furthermore, patients with sepsis (p=0.03) and patients sustaining acute renal failure (p=0.04) had significantly higher mortality. Pulmonary sepsis and its complications as well as preexisting comorbidity are the major reasons for fatal outcome, whereas the extent of surgical resection shows no significant influence. Emergent pneumonectomy as ultimate ratio is not only justified but also life saving. Further improvement seems achievable by earlier surgical intervention before the onset of pulmonary sepsis.

Severity of sepsis in patients with acute purulent destructive pulmonary disease depending on the presence of type 2 diabetes: impact on the forecast

Lung abscesses and gangrene are the most severe clinical manifestation and outcome among acute purulent destructive pulmonary disease (APDPD). Mortality ranges from 10 to 35%, and in the presence of diabetes increases up to 30 to 90% [1]. The main reason for this is the generalization of infection (sepsis), leading to the development of multiple organ failure [2,3]. The aim of this study was to identify the severity of sepsis in patients with APDPD depending on the presence of type 2 diabetes, and the impact on the forecast.

Management of acute necrotizing lung infections: The role of surgery

Background: There has been an increasing role of surgical intervention in managing patients with acute necrotizing lung infections and their complications, such as lung abscess and lung gangrene. Patients and Methods: In this retrospective study, conducted between 2003 and 2013, we presented patients of acute necrotizing pneumonia (ANP) and its complications, who required surgical interventions. Results: Twenty five patients required surgical management of their ANP. At the time of referral to cardiothoracic surgery all patients had evidence of ongoing sepsis despite the antibiotic therapy or have already developed complications. Patients presented with; persistent fever (n=18), cough with or without expectoration (n=25), hemoptysis (n=8), empyema (n=8), persistent air leak (n=3), severe hypoxia (n=3), septic shock (n=2), cachexia (n=6), leucocytosis (n=19), severe leuckopenia (n=3) and severe anemia (n=6). All patients were initially managed by internists, pneumologists and infectious disease teams for periods ranging from 1- 6 weeks prior to referral to cardiothoracic surgery. These patients required one or more of the following surgical procedures; anatomical lung resection (n=10), nonanatomical lung resection &amp; debridement (n=15), and other procedures (n=10). No pneumonectomies were done in our series. There was no intra-operative mortality and only one post-operative mortality in our series. Conclusion: Surgical intervention including major or limited lung resection, for unilateral necrotizing lung infections is a safe procedure for patients with persistent sepsis who are not responding adequately to medical therapy or who have already developed complications.

P-162EMERGENT PNEUMECTOMY FOR LUNG GANGRENE: DOES THE OUTCOME WARRANT THE PROCEDURE?

Background. Sloughing and gangrene of a complete lung are only very infrequently encountered complications of necrotizing pneumonia and fulminant pulmonary abscess formation. Thus far the role of emergent pneumonectomy is not established. Methods. The outcome of patients who underwent anatomic lung resection for lung gangrene at 3 centers for thoracic surgery during the last 13 years was retrospectively analyzed. Only cases of necrotizing pneumonia were included whereas malignant lesions were excluded.

Surgical Therapy for Necrotizing Pneumonia and Lung Gangrene

Necrotizing pneumonia, pulmonary abscess, and lung gangrene are rare complications of severe pulmonary infection with devitalization and sloughing of lung tissue. Pulmonary necrosis is often associated with alcoholism and other chronic disorders with known immunodeficiency. Mortality is significant and both treatment strategies as well as the role of surgery are controversially debated. In a retrospective review at a German tertiary referral hospital, 20 patients with pulmonary resection for necrotizing lung disorders were identified since 2008. At hospital admission, all patients suffered from pulmonary sepsis and despite adequate medical treatment progressing parenchymal destruction and devitalization took place. The majority of the patients sustained pleural empyema (13/20) and five patients a persisting air leak. On account of failing medical therapy, eight patients (40%) developed severe sepsis with septic shock and four patients (20%) were already preoperatively ventilated. Chronic alcoholism was present in 10 patients (50%). Gangrene of a complete lung was seen in four cases. Lobar gangrene or necrotizing pneumonia complicated by fulminate abscess was seen in the right lower lobe (8/20), middle lobe (4/20), right upper lobe (2/20), and left lower lobe (2/20). Procedures included pneumectomy (4/20), lobectomy (13/20), and limited resection (3/20). The bronchial stump was reinforced with a pedicle muscle flap in seven cases. There were three postoperative deaths due to septic shock with multiorgan failure. The remaining 17 patients (85%) recovered well and were transferred to rehabilitation clinics specialized on pulmonary disorders. Necrotizing pulmonary infections are infrequent but are life-threatening disease entities. Patients often present with severe comorbidity and chronic disorders causing immunodeficiency. If initial medical therapy fails surgery offers a reasonable therapeutic approach. Aim of surgical therapy is resection of all gangrenous lung parenchyma and effective drainage of pleural empyema. Then recovery is feasible in up to 80%.

Modern History of Surgical Management of Lung Abscess: From Harold Neuhof to Current Concepts

Harold Neuhof was one of the pioneers of thoracic surgery in the early decades of the last century. Inspired by his preceptor Howard Lilienthal he proposed an entirely new concept for surgery on acute lung abscess. The aim of his one-stage procedure was adequate drainage of the abscess cavity. His approach proved to be the first major breakthrough in the treatment of acute lung abscess. Therapy of pulmonary abscess was again radically changed by the advent of antibiotics in the late 1940s. However, the basic principles of Neuhof's concept still influence modern-day management of putrid lung abscess.

Necrotizing Pneumonia, Pulmonary Abscess, and Lung Gangrene

Contemporary Diagnostic Radiology: June 30, 2011 - Volume 34 - Issue 13 - p 6 doi: 10.1097/01.CDR.0000399283.60898.45

Necrotizing Pneumonia, Pulmonary Abscess, and Lung Gangrene

Necrotizing Pneumonia, Pulmonary Abscess, and Lung Gangrene

Morphological and structural variants of cellular and stromal interaction in a focus of destruction in acute lung abscess and lung gangrene in term of formation and stabilisation of fibrin-associated processes

Purulent and destructive lung diseases are often complicated by loss of anatomic structure of lung tissue, development of lung cirrhosis with subsequent respiratory and heart failure. We performed pathomorphological examination of operational and post mortem lung tissue specimens from 116 inpatients of 25 to 78 years of age with acute lung abscess or lung gangrene who was treated at a pulmonology center from 1999 to 2005. Acute lung inflammation tending to suppuration was characterized by pronounced cell reaction with no "fibrin blockage" and resulted in extended histolysis and abscess formation. "Young" fibrin was often found. Microvessels were fully passable, full-blooded with no fibrin into lumen. At subacute stage, fibrin was "maturing" with subsequent organization and growth of granulated tissue. Clinically, there were sequestered lung abscesses. Massive deposits of "young" and "maturing" fibrin formed "fibrin cocoon" with macrophages and neutrophils bricked up inside. Cell reaction was weak. There were swelling and desquamation of endothelium of microvessels, massive fibrin deposits into vessel lumen and prominent perivascular impregnation with fibrin. This pathological variant could lead to formation of abscess or pulmonary fibrosis with carnification. In cases of massive subtotal or total, often bilateral lung injury with weak delimiting of purulent and destructive process massive destructive zones with resting lung parenchyma faintly impregnated with fibrin were seen. There were no features of fibrin deposition inside microvessels. Functional activity of neutrophils and macrophages was greatly decreased. Therefore, the most favourable pathohistological variant appears to be formation of fibrin blockage consisted of "young" fibrin deposits; prominent cell reaction and absence of microcirculatory block. Structural changes of cells and stroma should be considered during pathological examination in order to provide optimal treatment strategy.