Anaerobic Bacillus Pyothorax with the Production of Gas and Severe Mediastinal Shift
Takeo Endo1) 4) Takefumi Saito1) Hirotaka Ohse1) 5) Mika Nakayama1) 2) Sadatomo Watanabe1) Kiyohisa Sekizawa2) Shizuo Hasegawa3)
1)Department of Internal Medicine, National Sanatorium Seiranso Hospital, Ibaraki, Japan
2)Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
3)Vice-President, University of Tsukuba, Ibaraki, Japan
4)Department of Internal Medicine, Mito Kyodo General Hospital, Ibaraki, Japan
5)Department of Internal Medicine, Ibaraki Prefectural University of Medical Sciences, Ibaraki, Japan
A 62-year-old man was admitted with the complaints of chronic sputum, dyspnea, and general weakness. Chest X-ray and computed tomographic films disclosed severe mediastinal shift and left lung collapse due to the accumulation of fluid and gas in the left pleural space. A puncture of the thoracic cavity yielded a milk-coffee-like purulent pleural effusion with stool odor, suggesting pyothorax with pneumothorax or broncho-pleural fistula. Chest tube drainage was performed. The elimination of gas was transient; subsequently, no air leaks were observed during deep breathing, suggesting the absence of pneumothorax and broncho-pleural fistula. An anaerobic culture of pleural effusion was prepared and a Bacteroides species was isolated. These clinical findings indicated that the intrathoracic gas could have been produced by anerobic bacilli. Systemic antibiotic chemotherapy with chest tube drainage achieved recovery. The production of gas in focal lesions is one noted symptom of anaerobic bacillus infection. However, to our knowledge, cases of anaerobic bacillus pyothorax generating large volumes of intrathoracic gas are rare.
Anaerobic bacteria Pyothorax Gas production Mediastinal shift Bacteroides species
Received 平成11年6月9日
JJRS, 38(1): 45-49, 2000