Abstract
The patient was a 54-year-old man with a history of myocardial infarction, emphysema, and hepatic dysfunction. He was diagnosed with a left lung abscess by his previous physician, and, as a result, had taken various antibiotics over a period of one month. At the time of transfer to our hospital, his left upper lobe had collapsed. Chronic pulmonary aspergillosis was suspected; however, a definite diagnosis had not been made. Prior to surgery, embolization was performed in the bronchial and abnormal arteries flowing from the thoracic wall, and the left upper lobe was resected through a postero-lateral thoracotomy at the 5th intercostal space. Although marked adhesion was present between the left upper lobe and thoracic wall, there was only a small amount of blood loss during dissection of the adhesion. The final diagnosis was chronic aspergillosis. Approximately 2 weeks after surgery, infectious pneumonia developed. Broad spectrum antibiotics and itraconazole were administered, and the symptoms improved within 2 weeks. Preoperative arterial embolization for chronic pulmonary infection can reduce the amount of intraoperative blood loss. Following the long-term administration of antibiotics, it can be difficult to identify pathogens causing postoperative pneumonia in patients with pulmonary infection who are eligible for surgery. These pathogens may become resistant to many antibiotics, and caution should be exercised when choosing antibiotics and antifungal agents.
