Vishnukanth Govindaraj

Abstract

Brain abscess can result from spread of infection from contiguous sites or from distant hematogenous spread. Hematogenous spread from a distant site as from the lungs is more common with cyanotic congenital heart disease and in patients with infective endocarditis. We report a case of hematogenous spread of brain abscess from lung in a patient who had no concurrent heart disease. Klebsiella pneumonia was isolated both from brain abscess and from lung abscess. A fifty years old lady with uncontrolled sugars presented with cough with expectoration and fever. Chest X ray showed cavity with fluid level on the right side and sputum culture showed Klebsiella pneumoniae. She was treated with sensitive antibiotics. During in hospital stay she developed headache and blurring of vision. CT brain showed a right parietal lobe abscess. She underwent decompression procedure and abscess from brain was drained which also revealed growth of Klebsiella pneumoniae. Her echo was normal. She was treated with sensitive antibiotics and had clinical improvement. While treating a case of lung abscess, clinicians should be aware of the possibility of metastatic spread and a high index of suspicion and a radiological imaging leads to early diagnosis and treatment.   Keywords: Lung abscess, Hematogenous spread, Brain abscess, Klebsiella

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Abstract

Background: Lung is one of the commonest site for malignant neoplasms, both primary and metastatic. Primary lung malignancies are presently heading the list of common cancers worldwide and accounts for more death than any other cancer. In lung cancer, diagnosis of histological type is of great significance to determine the prognosis and for planning the treatment. Radiology and imaging plays an integral part in diagnosis, management, staging and follow-up of lung cancer patients. Moreover, radiology can give vital clues towards histological diagnosis of the malignancy. Our study aims to analyse the clinical, radiological and histological patterns occurring in patients with primary lung cancer. Materials and Methods: A total of 116 patients with clinical and radiological features suggestive of primary lung cancer were enrolled. Diagnosis of lung cancer was established histopathologically. Clinico-pathological profile and histopathological analysis was done individually for all patients. Results: Our study included a total of 116 cases with 84 males (72%) and 32 (28%) female patients with a median age of 60 years (range 19-90 years). The most common histological type of lung cancer was adenocarcinoma, in 79(69.82%) of patients followed by squamous cell carcinoma in 22 patients (18.96%). Adenocarcinoma was the most common type among both males and females. Also adenocarcinoma was the commonest histological pattern among non-smokers. The most common clinical presentation was cough with expectoration. Radiologically most common feature was mass lesion (86.2%). Seventy four patients (63.78%) with non-small cell lung cancer had metastatic disease, the most common being malignant pleural effusion. Six out of seven patients of small cell cancer had extensive stage. Conclusions: Adenocarcinoma is the commonest histological pattern of lung cancer even in smokers. Lung cancer is not necessarily a disease of old age. Majority of the patients still present in advanced stages. A good screening method for lung cancer is the need of the hour. Keywords: Adenocarcinoma; Primary lung cancer; Pathological profile.

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