• Tuberculosis and Respiratory Diseases
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• v.57 no.4
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• pp.381-385
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• 2004

Pulmonary gangrene is a rare and severe complication of bacterial pneumonia, where a pulmonary segment or lobe is sloughed due to parenchymal devitalization of the parenchyma, with secondary anaerobic infection and necrosis caused by pulmonary vascular thrombosis. Prior to the antibiotic era, massive pulmonary gangrene was potentially fatal. Herein, a case of pulmonary gangrene in a 67-year-old man is reported. He complained of fever, chills, dyspnea and purulent sputum of 5 days duration. The plain chest radiograph showed well-marginated right upper lobe consolidation, with bulging minor fissure, suggestive of a Klebsiella infection. A contrast CT scan demonstrated consolidation of the right upper lobe, with a central necrotizing portion. Klebsiella species was confirmed from both sputum and blood cultures. After appropriate antibiotics, the chest X-ray and CT scan 3 weeks later showed a large cavity with an air-fluid level, sloughing-off and extrusion of necrotic lung tissue, suggestive of pulmonary gangrene. Seven months later, the right gangrenous lung showed severe volume loss on a chest radiograph. The management of pulmonary gangrene has been somewhat controversial. Herein, it was managed without surgical drainage or resection. If the antibiotic therapy had failed, then a surgical approach would have been considered.

• Tuberculosis and Respiratory Diseases
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• v.46 no.4
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• pp.591-595
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• 1999

Pulmonary gangrene is a rare complication of severe pulmonary infection in which a pulmonary segment or lobe is sloughed. It is a part of a spectrum of disease in which lung tissue is devitalized(such as necrotizing pneumonia, pulmonary abscess), but apart from them, pulmonary gangrene has more extensive area of necrosis and thrombosis of large vessels plays a prominent role in the pathogenesis. We experienced a case of pulmonary gangrene in 71 year old female obstructive pneumonia patient with non-small cell lung carcinoma. She complained high fever, chill and despite treatment with antibiotics, pneumonia progressed to empyema. At that time chest radiograph showed a large cavity including sloughed lung tissue, freely moving to dependent position at both lateral decubitus view. RML and RLL were resected and compression of pulmonary vessels by enlarged lymph nodes was observed. Defervescence was obtained immediate postoperative period and the patient was discharged after infection control with antibiotics, chest tube drainage. The perivascular lymph nodes dissected during lobectomy were proved to be reactive hyperplasias. We speculated that the carcinoma caused obstructive pneumonia, in turn, resulted in reactive hyperplasia of the draining lymph nodes surrounding the large vessels and finally the lung tissues supplied by them necrotized and sloughed.

• Journal of Chest Surgery
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• v.32 no.5
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• pp.484-488
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• 1999

Massive lung gangrene is a rare but very rapidly progressing fatal complication of lobar pneumonia. Etiologic agents are Klebsiella pneumoniae, Pneumococcus and Aspergillus, etc. Chest X-ray shows firm consolidation of the involved pulmonary lobe and bulging fissure due to the volume expansion of involved lung. CT-scan shows extensive lung parenchymal destructions with multiple small cavitary lesions. Recommended treatment is the early surgical intervention combined with antibiotics. Without surgical intervention, lung gangrene is known to progress toward sepsis, multiorgan failure, and high mortality. We report two cases of rapidly progressing massive lung gangrene by Klebsiella pneumonia treated by the resectional surgery.

• Journal of Physiology & Pathology in Korean Medicine
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• v.20 no.2
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• pp.292-304
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• 2006

The Atrophy of lung among chronic asthenia disease is a kind of tuberculosis. It is divided in two types. One is the Atrophy of lung with consumptive fever, the other is the Atrophy of lung with consumptive cold. Four prescriptions can be used treat this disease. Pulmonary abscess(肺癰) is infected by poisonous fatcors of wind and heat. It's symptoms like coughing, chest pain, fever and phlegm with pus after coughing are appeared generally, in case of serious condition, pyemia after coughing can be appeared. This disease is applicable to lung abscess, bronchiectasis, lung gangrene. Six prescriptions can be used to treat this disease. Coughing and congestion of the head(咳嗽上氣) is called Lung-distension(肺腸). Its symptom is dyspnea caused by more expiration rather than inspiration. This disease is divided into two types like chronic asthenia type and inflammatory type. Seven prescriptions can be used to treat this disease.

• Tuberculosis and Respiratory Diseases
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• v.43 no.5
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• pp.779-785
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• 1996

Wegener's granulomatosis is characterized by necrotizing granulomatous vasculitis affecting upper and lower respiratory tracts and kidneys. Vascular lesions commonly involve capillaries and small vessels but, less commonly larger vessels. We report a 46-year-old male patient of Wegener's granulomatosis associated with paranasal sinusitis, pulmonary consolidations, glomerulonephritis, skin lesions with obstruction of both anterior tibial and peroneal arteries. Several necrotic lesions of the toes had progressed to gangrene and both transmetatarsal amputations were done. The patient continued to receive cyclophosphamide and prednisolone.