Fatal Hemoptysis Due to Lung Abscess and Pulmoaortic Fistula

21 Feb
2015

Fatal Hemoptysis Due to Lung Abscess and Pulmoaortic FistulaMassive hemoptysis is a well known complication of lung abscess. Pathologic studies suggest that this is usually due to erosion of the infection into a pulmonary artery. We wish to present an unusual case of massive hemoptysis complicating lung abscess in which the infection eroded into the thoracic aorta. We have been unable to find a similar case in the literature. In addition to a case presentation, the roentgenographic and pathologic features will be discussed. actos tablets

Case Report
The patient was a 79-year-old man who was admitted to the hospital because of general weakness, malaise, and mild diarrhea of one weeks duration. He was an insulin-dependent diabetic with a past history of alcohol abuse resulting in pancreatitis and pseudocyst formation, which required surgery six years prior to admission. There was no history of tuberculosis. He was a nonsmoker. Recent alcohol use was denied.
The admission physical examination revealed a cachectic elderly man with a temperature of 37.3°C. Lung, heart, and abdominal examination results were normal. The white blood cell count was 14.5 with 75 neutrophils and four band cells. The hematocrit value was 37.2 percent. Results from clotting studies and other chemistries, including amylase and lipase, were normal. The chest x-ray film (Fig 1) revealed extensive aortic arch calcification and a double density left of the trachea, interpreted as an ectatic arch. The urinalysis showed pyuria.
He was admitted with presumed urinary tract infection and possibly sepsis. After appropriate cultures were taken, ampicillin and gentamicin were begun. Staphylococcus aureus, however, grew from two blood cultures and the urine. His antibiotic therapy was changed to oxacillin. On the second hospital day, hematemasis developed. Endoscopy showed no bleeding site. The following day, he was found in respiratory distress and intubation was required. A chest x-ray film (Fig 2) showed a new parenchymal density in the left apex.

Figure 1. Admission chest x-ray film showing clear lungs and a tortuous aorta which is heavily calcified.

Figure 1. Admission chest x-ray film showing clear lungs and a tortuous aorta which is heavily calcified.

Figure 2. Chest x-ray film on the second hospital day after intubation for respiratory distress. A mass is seen adjacent to the aortic arch.

Figure 2. Chest x-ray film on the second hospital day after intubation for respiratory distress. A mass is seen adjacent to the aortic arch.

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