Pulmonary infections imitating lung cancer: clinical presentation and therapeutical approach
Pulmonary infections occasionally present with infectious pseudotumour of the lung not easily distinguishable from true pulmonary neoplasm. In such cases, radiographic findings and clinical manifestation are highly suggestive of lung cancer. These inflammatory lung lesions cause significant diagnostic problems and appropriate therapy is often considerably delayed. We therefore report on our experience with infectious pseudotumour of the lung caused by bacterial, mycobacterial and fungal pulmonary infections.
In a retrospective case series, patients with lung infections simulating pulmonary carcinoma were identified. Clinical presentation, radiological features, surgical procedures and outcome were analysed.
There were seven male and six female patients with a mean age of 53 years. Presumed pulmonary carcinoma and hemoptysis were main reasons for hospital admission. Procedures performed were video-assisted thoracoscopic wedge resection (6), lobectomy (5), video-assisted thoracoscopic lobectomy and open wedge resection each in one case. Pathologic examination of the obtained specimens revealed tuberculoma (5), aspergilloma (3), pulmonary actinomycosis related pseudotumour (3) and coccidioidoma (2). Following definite diagnosis, patients with tuberculosis and fungal infections received antituberculotic and antifungal medications, respectively. Patients suffering from pulmonary actinomycosis received penicillin. There was no in-hospital mortality. One re-thoracotomy was mandatory because of pleural empyema.
Pulmonary infections simulating lung cancer require surgical removal both for establishing definite diagnosis and to manage complications like haemoptysis and ongoing contamination of the airways by infectious agents. Whenever feasible, limited thoracoscopic resections are preferable. Following definite diagnosis antimicrobial drug therapy for a sufficient length of time is mandatory.
KeywordsTuberculoma Aspergilloma Coccidioidomycosis Pulmonary actinomycosis Hemoptysis
Conflict of interest
- 1.Madhusudhan KS, Gamanagatti S, Seith A, Hari S (2007) Pulmonary infections mimicking cancer: report of four cases. Singap Med J 48:e327–e331Google Scholar
- 13.Riquet M, Souliamas R (1997) Surgery of thoracic and pulmonary tuberculosis and the sequelae of its treatment in adults. Rev Mal Respire 14(Suppl 5):S105–S120 (article in French)Google Scholar
- 16.Rixford E (1894) Case for diagnosis presented before the San Francisco Medico-Chirurgical Society, Mar. 5, 1894. Occidental Med Times 8:326Google Scholar
- 17.Rixford E (1894) A case of protozoic dermatitis. Occidental Med Times 8:704–707Google Scholar
- 18.Ophuls W, Moffitt HC (1900) A new pathogenic mould (formerly described as a protozoon: Coccidioides immitis pyogenes): preliminary report. Phila Med J 5:1471–1472Google Scholar
- 21.Palmer CE, Edwards PQ, Allfather WE (1957) Characteristics of skin reactions to coccidioidin and histoplasmin with evidence of an unidentified source of sensitivity in some geographic areas (Abstract). In: Symposium on Coccidioidomycosis, Phoenix, Arizona. Atlanta: Communicable Disease Center, 171–180, PHS publication no. 575Google Scholar
- 25.Cairns L, Blythe D, Kao A et al. (1997) An outbreak of coccidioidomycosis in Washington State traveler returning from Mexico (Abstract). In: Program and abstracts—37th interscience conference on antimicrobial agents and chemotherapy, American Thoracic Society for Microbiology, Washington DCGoogle Scholar