Learning objectives
- To know the incidence of necrotizing pneumonia in our health area in the last 5 years.
- Describe the most relevant radiological findings for its correct diagnosis.
Background
Necrotizing pneumonia is a severe and rare complication of an infectious respiratory process - community-acquired pneumonia (CAP).
It's described around 30-75% mortality.
Bacterial is the most frequent etiology (S.
aureus,
S.
pneumoniae,
K.
pneumoniae,
P.
aeruginosa,
other bacteria).
Fungus is less frequent and predominates in immunosuppressed patients.
The most relevant risk factor mentioned in the literature is immunosuppression,
which can be aggravated by alcoholic and tobacco habits,
diabetes mellitus,
heart failure,
chronic liver disease,
etc ...
During an infectious respiratory process with the development of...
Findings and procedure details
From 2013 to 2018 we diagnosed 20 cases of necrotizing pneumonia (13 male and 7 female).
The average age of these patients was 66 years old.
Only 5 of the total cases (25%) wereimmunosuppressed patients due to diabetes mellitus and neoplasia,
among others,
and 9 of the 20 cases (45%) were smokers.
In relation to bacterial etiology,
the most frequent was S.
aureus and P.
aeruginosa but is important to describe that the most common result in the culture was negative.
The most common location...
Conclusion
- Necrotizing pneumonia is an uncommon but very serious complication of bacterial community pneumoniawith high morbidity and mortality.
- Male smokers with some degree of immunodeficiency are the population at risk.
- The pathogen responsible for this disease is seldom identified.
-Most common chest-CT findings are consolidation with inner small low attenuation areas (air cavities,
sometimes withhydro-aerial levels),
pleural effusion and/or empyema.
References
-N.
Chatha,
D.
Fortin,
K.J.
Bosma.
Management of necrotizing pneumonia and pulmonary gangrene: A case series and review of the literature.
Can Respir J.
2014 Jul-Aug;21(4):239-45.
-M.
Parra,
F.
Gattini,
F.
Descalzi,
G.
Schiappacasse.
Neumonías necrosantes graves con empiema asociado.
Rev Chil Cir.
2016;68(5):379-383.
-Yueh-Feng T and Yee-Huang Ku.
Necrotizing pneumonia: a rare complication of pneumonia requiring special consideration.
Curr Opin Pulm Med 2012;18:246-252.
-M.
Alifano,
C.
Lorut,
A.
Lefebvre,
L.
Khattar,
D.
Damotte,
G.
Huchon et al.
Necrotizing pneumonia in adults: multidisciplinary management.
Intensive...