THORACIC ACTINOMYCOSIS

Thoracic actinomycosis is a rare disease without characteristic clinic al signs. Approximately 90% of patients suffering from thoracic actino mycosis have undergone diagnostic and therapeutic procedures based on a wrong diagnostic hypothesis (malignancies 35-44%, other pulmonary di sorders 33-35%). The opportunities for a timely and adequate diagnosis by the use of clinical examination, laboratory studies, microbiology studies, radiologic imaging or invasive measures are limited. In 85%, thoracic actinomycosis has not been identified prior to thoracotomy, o pen biopsy and histological examination. Based on a wrong diagnostic h ypothesis, resective thoracic surgery according to the principles of o ncologic surgery can hardly be avoided. We report on a 43-year-old mal e suffering from actinomycosis of the left hemithorax. Clinical signs, differential diagnosis, treatment and clinical course are described. The role of surgery in the treatment protocol of thoracic actinomycosi s is discussed. In pulmonary and pleural disorders of unknown origin, differential diagnosis should include thoracic actinomycosis as early as possible. Due to the considerably high mortality rate of untreated disease, the outcome of thoracic actinomycosis can only be improved by a timely and combined employment of surgical and antibiotic therapy.