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Case No. 614
2022-01-01~2022-01-31
출제자 : 서종현
Hit : 653
| Period | 2022-01-01~2022-01-31 |
|---|---|
| Diagnosis | Actinomycosis |
| Gender |
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| Age | 77 |
| Clinical information | 1주일 전부 만져진 right neck mass를 주소로 내원한 77세 여자환자이다. 진단은? |
| Discussion | Actinomycosis US-guided core needle biopsy를 시행하여 chronic active inflammation with sulfur granules, consistent with actinomycosis로 진단됨. 1. Introduction Chronic suppurative bacterial infection caused by Actinomyces species - Gram-positive non-spore-forming anaerobic (m/c in human: A. israelii) - Endogenous flora in the mouth, GI tract, and female genital tract Predisposing factor: disruption of mucosal barrier (surgery, inflammation, foreign body, poor dental hygiene) Location: cervicofacial (50-65%) > thoracic (15-30%) > abdominopelvic (20%) > CNS, musculoskeletal, disseminated Pathology: Sulfur granules, branching filaments rods on GMS stain - Dense fibrosis, abscess formation, draining sinuses Treatment: antibiotics (penicillin) for prolonged period +/- surgery 2. Radiologic findings Infiltrative solid mass with internal small necrotic/cystic portion or cystic mass with irregularly thickened wall Highly infiltrative nature (due to proteolytic enzyme) - Extensively speared beyond normal fascial and connective tissue planes - Invasion and infiltration of adjacent tissue and organs Strong contrast enhancement in solid portion of mass Small rim-enhancing abscesses within mass Sinus fistula, venous thrombosis |
| Correct answer |
Correct AnswerSemi-Correct Answer |