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Review
. 2014 Jul-Aug;21(4):239-45.
doi: 10.1155/2014/864159. Epub 2014 May 2.

Management of necrotizing pneumonia and pulmonary gangrene: a case series and review of the literature

Neela Chatha, Dalilah Fortin, Karen J Bosma
Review

Management of necrotizing pneumonia and pulmonary gangrene: a case series and review of the literature

Neela Chatha et al. Can Respir J. 2014 Jul-Aug.

Abstract
in English, French

Background: Necrotizing pneumonia is an uncommon but severe complication of bacterial pneumonia, associated with high morbidity and mortality. The availability of current data regarding the management of necrotizing pneumonia is limited to case reports and small retrospective observational cohort studies. Consequently, appropriate management for these patients remains unclear.

Objective: To describe five cases and review the available literature to help guide management of necrotizing pneumonia.

Methods: Cases involving five adults with respiratory failure due to necrotizing pneumonia admitted to a tertiary care centre and infected with Streptococcus pneumoniae (n=3), Klebsiella pneumoniae (n=1) and methicillin-resistant Staphylococcus aureus (n=1) were reviewed. All available literature was reviewed and encompassed case reports and retrospective reviews dating from 1975 to the present.

Results: All five patients received aggressive medical management and consultation by thoracic surgery. Three patients underwent surgical procedures to debride necrotic lung parenchyma. Two of the five patients died in hospital.

Conclusions: Necrotizing pneumonia often leads to pulmonary gangrene. Computed tomography of the thorax with contrast is recommended to evaluate the pulmonary vascular supply. Further study is necessary to determine whether surgical intervention, in the absence of pulmonary gangrene, results in better outcomes.

HISTORIQUE :: La pneumonie nécrosante est une complication peu courante, mais grave, de la pneumonie bactérienne, qui s’associe à une morbidité et une mortalité élevées. Les données sur sa prise en charge sont limitées à des rapports de cas et à de petites études rétrospectives de cohortes par observation. Par conséquent, la prise en charge convenable de ces patients n’est pas claire.

OBJECTIF :: Décrire cinq cas et analyser les publications pour orienter la prise en charge de la pneumonie nécrosante.

MÉTHODOLOGIE :: Les chercheurs ont analysé le cas de cinq adultes ayant une insuffisance respiratoire causée par la pneumonie nécrosante, hospitalisés dans un centre de soins tertiaires et infectés par le Streptococcus pneumoniae (n=3), le Klebsiella pneumoniae (n=1) ou le Staphylococcus aureus résistant à la méthicilline (n=1). Ils ont analysé toutes les publications et inclus les rapports de cas et les analyses rétrospectives de 1975 à maintenant.

RÉSULTATS :: Les cinq patients ont reçu une prise en charge médicale dynamique et une consultation en chirurgie thoracique. Trois patients ont subi des interventions chirurgicales pour débrider un parenchyme pulmonaire nécrotique. Deux des cinq patients sont décédés à l’hôpital.

CONCLUSION :: La pneumonie nécrosante est souvent responsable d’une gangrène pulmonaire. La tomodensitométrie de contraste du thorax est recommandée pour évaluer la capacité vasculaire pulmonaire. D’autres études s’imposent pour déterminer si, en l’absence de gangrène pulmonaire, une intervention chirurgicale donne de meilleurs résultats cliniques.

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Figures

Figure 1)
Figure 1)
A Chest x-ray for case 2. Multifocal pneumonia with an area of lucency in the right lower lobe (open arrow), concerning for abscess formation. B, C and D Noncontrast computed tomography scan of the thorax, axial views for case 2, performed within 24 h of chest x-ray (A) showing large irregular cavities destroying the right middle and right lower lobes (open arrows), the extent of which was not apparent on plain film. A chest tube is present on the right side (solid black arrow). In addition there are widespread multifocal ground-glass opacities (solid white arrow) in the left lung with a moderate left pleural effusion (solid grey arrow)
Figure 2)
Figure 2)
Computed tomography scan of the thorax with contrast, coronal views, for case 4. A There is a large cavity in the right upper lobe (open arrow) and B multiple smaller abscesses located posteriorly in the right apex (open arrows), with decreased attenuation of the right upper lobe (solid white arrow), although the vessels in the right upper lobe are patent. The decreased perfusion and multiple small abscesses in addition to the large abscess cavity are consistent with a radiographic diagnosis of necrotizing pneumonia
See this image and copyright information in PMC

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