Necrotizing Pneumonia: A Practical Guide for the Clinician

Abstract

While rare, necrotizing pneumonia is a severe and potentially life-threatening manifestation of lung parenchyma infection. Initially documented in the 1940s, it was a significant contributor to mortality rates in both adults and children, with figures reaching up to 45%. Despite being a disease described in the literature for decades, data on the management of necrotizing pneumonia remain limited. Most available information comes from retrospective observational cohort studies. This article aims to provide a comprehensive summary of the existing literature on the subject.

Keywords: necrotizing pneumonia; pulmonary gangrene; sepsis; septic emboli.

Figure 1

A depiction of the pathogenesis of pneumonia. The interaction of the pathogens with alveolar macrophages and the airway initiates the host response with the local and systemic release of inflammatory mediators and neutrophil recruitment. A distinguishing feature of necrotizing pneumonia is the role that bacterial toxins often play in the pathogenesis.

Figure 2

CT scans of a patient with necrotizing pneumonia and progression through time, with row (D) representing images after the completion of treatment. The time between images in row (A) and row (D) is six weeks. Row (B,C) represent CTs that were taken in between the time of row (A) and row (D), showing the progression of improvement.

Figure 2

CT scans of a patient with necrotizing pneumonia and progression through time, with row (D) representing images after the completion of treatment. The time between images in row (A) and row (D) is six weeks. Row (B,C) represent CTs that were taken in between the time of row (A) and row (D), showing the progression of improvement.

Figure 3

A CT scan of a patient with radiographic evidence of septic emboli.

Figure 4

A chart depicting potential complications from necrotizing pneumonia and a summary of the recommendations for management.