Thoracic Actinomycosis: CT Features with Histopathologic Correlation
Tae Sung Kim1,
Joungho Han2,
Won-Jung Koh3,
Jae Chol Choi3,
Myung Jin Chung1,
Ju Hyun Lee1,
Sung Shine Shim1 and
Semin Chong1
1 Department of Radiology and Center for Imaging Science, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul 135-710,
South Korea.
2 Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul 135-710,
South Korea.
3 Department of Medicine, Division of Pulmonary and Critical Care Medicine,
Samsung Medical Center, Sungkyunkwan University School of Medicine,
Gangnam-gu, Seoul 135-710, South Korea.
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Fig. 1A —51-year-old man with early stage parenchymal actinomycosis.
High-resolution CT image (1-mm collimation) shows poorly defined peripheral
pulmonary nodule in right lower lobe. Note surrounding areas of ground-glass
attenuation.
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Fig. 1B —51-year-old man with early stage parenchymal actinomycosis.
Photograph of wedge resection specimen shows poorly defined nodule
(arrows) formed by dense infiltration of many neutrophils and
lymphocytes. Note surrounding areas of intraalveolar fibrinous exudate with
some inflammatory cell infiltration (stars), which correspond to
areas of ground-glass attenuation on CT. (H and E, x1)
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Fig. 2 —61-year-old man with early-stage parenchymal actinomycosis.
Delayed contrast-enhanced CT image obtained with mediastinal window settings
shows small subpleural nodule in left upper lobe. Note central low-attenuation
area with peripheral enhancing portion of nodule and adjacent pleural
thickening (arrows). Actinomycosis was diagnosed using percutaneous
transthoracic core biopsy.
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Fig. 3A —61-year-old woman with parenchymal actinomycosis manifesting
as subsegmental consolidation. Contrast-enhanced CT image obtained with
mediastinal window settings shows subsegmental consolidation in posterior
segment of right upper lobe. Consolidation shows central low-attenuation area
with peripheral contrast enhancement. Note peripheral bronchiectasis
(arrow) and adjacent loculated pleural effusion.
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Fig. 3B —61-year-old woman with parenchymal actinomycosis manifesting
as subsegmental consolidation. Image of A obtained with lung window
settings shows triangular subsegmental consolidation contains ectatic bronchi
(arrow) with surrounding areas of ground-glass attenuation.
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Fig. 4A —42-year-old man with parenchymal actinomycosis manifesting as
necrotic peripheral mass. Delayed contrast-enhanced CT image obtained with
mediastinal window settings shows poorly defined subpleural mass with
low-attenuation area (arrow) in right lower lobe.
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Fig. 4B —42-year-old man with parenchymal actinomycosis manifesting as
necrotic peripheral mass. Image of A obtained with lung window settings
shows irregularly marginated mass with patchy areas of groundglass attenuation
and interlobular septal thickening (arrows).
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Fig. 4C —42-year-old man with parenchymal actinomycosis manifesting as
necrotic peripheral mass. Photograph of gross specimen from wedge resection of
right lower lobe shows peribronchial cavitary mass (arrows). Note
mild thickening of proximal bronchus (arrowheads). Scale: cm.
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Fig. 4D —42-year-old man with parenchymal actinomycosis manifesting as
necrotic peripheral mass. Photomicrograph of histopathologic specimen shows
bronchiectasis with surrounding areas of dense infiltration of inflammatory
cells and fibrosis. Note intraluminal granulation tissue (star) and
Actinomyces colonies (arrow) within ectatic bronchus.
Additional Actinomyces colonies (arrowheads) also are noted
within lung parenchyma. (H and E, x1)
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Fig. 5A —60-year-old man with parenchymal actinomycosis manifesting as
lobar consolidation. Contrast-enhanced CT images obtained with mediastinal
window settings reveal right upper lobe lobar consolidation. Consolidation
shows significant contrast enhancement with multifocal low-attenuation areas
(black arrowheads). Note bronchiectasis (arrow, A)
within consolidation and enlargement of right paratracheal lymph node
(white arrowhead, A).
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Fig. 5B —60-year-old man with parenchymal actinomycosis manifesting as
lobar consolidation. Contrast-enhanced CT images obtained with mediastinal
window settings reveal right upper lobe lobar consolidation. Consolidation
shows significant contrast enhancement with multifocal low-attenuation areas
(black arrowheads). Note bronchiectasis (arrow, A)
within consolidation and enlargement of right paratracheal lymph node
(white arrowhead, A).
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Fig. 6 —80-year-old man with parenchymal actinomycosis manifesting as
pulmonary mass. Contrast-enhanced CT image obtained with mediastinal window
settings shows mass replacing lingular division of left upper lobe. Note
multiple large areas of low attenuation within enhancing mass and adjacent
pleural thickening and ipsilateral dependent pleural effusion.
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Fig. 7A —67-year-old man with parenchymal actinomycosis that resolved
completely after treatment with antibiotic medication. Contrast-enhanced CT
image obtained with mediastinal window settings shows segmental consolidation
containing central low-attenuation area and several cavities.
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Fig. 7B —67-year-old man with parenchymal actinomycosis that resolved
completely after treatment with antibiotic medication. CT image obtained with
lung window settings at same level as A after 7 months of antibiotic
therapy with amoxicillin and clavulanic acid shows complete resolution of
consolidation with only residual parenchymal scarring (arrows)
evident.
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Fig. 8 —39-year-old man with parenchymal actinomycosis and pleural
effusion. Contrast-enhanced CT image obtained with mediastinal window settings
shows right middle lobe consolidation and moderate-sized pleural effusion.
Note central low-attenuation area (arrow) within consolidation and
mucoid impaction within bronchus (arrowhead).
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Fig. 9A —57-year-old man with parenchymal actinomycosis manifesting as
chronic necrotizing pneumonia with transfissural extension. Contrast-enhanced
CT image obtained with mediastinal window settings shows extensive parenchymal
consolidation in superior segment of right lower lobe with areas of necrosis
and multiple small cavities. Note subcarinal lymphadenopathy (arrow)
and hypertrophied intercostal artery (arrowheads) supplying chronic
necrotizing pneumonia.
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Fig. 9B —57-year-old man with parenchymal actinomycosis manifesting as
chronic necrotizing pneumonia with transfissural extension. Coronal
reformation of contrast-enhanced CT image shows transfissural extension
(arrow) of necrotic consolidation from superior segment of right
lower lobe (large star) into upper lobe (small star). Note
thickening of adjacent interlobar fissure (arrowheads).
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Fig. 9C —57-year-old man with parenchymal actinomycosis manifesting as
chronic necrotizing pneumonia with transfissural extension. Photograph of
right pneumonectomy specimen shows large cavitary lesion in superior segment
of right lower lobe (large star), communicating with another cavitary
lesion in right upper lobe (small star) through transfissural
extension (arrow). Note thickening of adjacent interlobar fissure
(arrowheads). Scale: cm.
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Fig. 10A —48-year-old man with actinomycosis associated with
bronchiectasis. High-resolution CT image obtained with 1-mm collimation shows
bronchial wall thickening and bronchiectasis in right lower lobe
consolidation.
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Fig. 10B —48-year-old man with actinomycosis associated with
bronchiectasis. Contrast-enhanced CT image obtained with mediastinal window
settings at lower level than A shows air-fluid level (arrow)
within bronchiectatic airway.
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Fig. 10C —48-year-old man with actinomycosis associated with
bronchiectasis. Photograph of specimen obtained from right lower lobectomy
shows bronchiectasis (stars) and bronchial wall thickening with
inflammation and fibrosis. Note Actinomyces colonies
(arrows) within lumen of ectatic bronchus.
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Fig. 11A —47-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Contrast-enhanced CT image obtained with mediastinal
window settings shows small broncholith (arrow) obstructing bronchial
lumen that supplies superior segment of right lower lobe. More distally,
necrotic subsegmental consolidation containing mucoid material and another
broncholith (arrowhead) is seen with bronchial dilatation. Also note
small calcified hilar and subcarinal lymph nodes, suggesting previous
tuberculous infection.
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Fig. 11B —47-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Contrast-enhanced CT image obtained at lower level than
A shows triangular subsegmental consolidation contains typical
low-attenuation area with adjacent pleural thickening
(arrowheads).
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Fig. 11C —47-year-old man with endobronchial actinomycosis associated
with broncholithiasis. Photomicrograph of histopathologic specimen of
endobronchial calcified nodule after decalcification shows numerous
filamentous structures (arrow) representing Actinomyces
organisms covering broncholith (B). (Grocott-Gomori methenamine-silver stain,
x200)
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Fig. 12A —56-year-old man with endobronchial actinomycosis associated
with foreign body (chicken bone). Contrast-enhanced CT image obtained with
mediastinal window settings shows small endobronchial calcification
(arrow) obstructing lumen of bronchus intermedius. Note surrounding
areas of low attenuation around endobronchial calcification, suggestive of
necrotic material.
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Fig. 12B —56-year-old man with endobronchial actinomycosis associated
with foreign body (chicken bone). CT image obtained with lung window settings
at lower level than A shows air-space consolidations and areas of
ground-glass attenuation in right middle and lower lobes, suggestive of
obstructive pneumonia.
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Fig. 12C —56-year-old man with endobronchial actinomycosis associated
with foreign body (chicken bone). Photomicrograph of specimen obtained from
bronchoscopic removal of endobronchial calcification reveals chicken bone,
which was surrounded by acute suppurative inflammation containing multiple
Actinomyces colonies in background of numerous neutrophils. (H and E,
x200)
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Fig. 13 —47-year-old woman with both parenchymal and endobronchial
actinomycosis associated with broncholithiasis. Contrast-enhanced CT image
obtained with mediastinal window settings shows small endobronchial
calcification (white arrow) obstructing lumen of posterobasal
segmental bronchus of left lower lobe. Masslike consolidation
(arrowhead) containing several cavities is also seen in anterobasal
segment of left lower lobe. Notice adjacent pleural thickening (black
arrow). Endobronchial actinomycosis was diagnosed by bronchoscopic
biopsy, and parenchymal actinomycosis was diagnosed by wedge resection.
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Copyright © 2006 by the American Roentgen Ray Society.
