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. 1993 Jan;48(1):70–74. doi: 10.1136/thx.48.1.70

Pulmonary gangrene and the air crescent sign.

J M Reich 1
PMCID: PMC464251  PMID: 8434358

Abstract

BACKGROUND: A study was carried out to increase familiarity with the aetiology, pathogenesis, and radiographic features that characterise pulmonary gangrene. PATIENTS: Four patients with one of the disorders vasoinvasive aspergillosis, infarcted tuberculous cavity, chronic necrotising aspergillosis, and gangrene due to Pseudomonas aeruginosa were selected because they showed the variations of the typical radiographic pattern and illustrated the pathogenesis. A fifth case is also presented, in which pulmonary gangrene was simulated by the invagination of a loculated pleural effusion into the wall of a contiguous lung abscess. CONCLUSIONS: Evolution of a crescent or rim of air within a homogeneous shadow is the feature that both heralds the development and facilitates the recognition of pulmonary gangrene. It is most often the result of vascular thrombosis induced by the infecting organism. The outcome of treatment is often unfavourable, principally because of the severity of the predisposing systemic or local underlying disorder, although a delay in diagnosis, possibly due to unfamiliarity with the radiographic pattern, may have contributed to the adverse outcome in some instances.

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Selected References

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  1. Binder R. E., Faling L. J., Pugatch R. D., Mahasaen C., Snider G. L. Chronic necrotizing pulmonary aspergillosis: a discrete clinical entity. Medicine (Baltimore) 1982 Mar;61(2):109–124. doi: 10.1097/00005792-198203000-00005. [DOI] [PubMed] [Google Scholar]
  2. Cameron D. I., Stewart J. D., Slack R. C., Lewis C. L. Letter: Massive pulmonary gangrene. Can Med Assoc J. 1975 Jun 7;112(11):1290–1290. [PMC free article] [PubMed] [Google Scholar]
  3. Curtis A. M., Smith G. J., Ravin C. E. Air crescent sign of invasive aspergillosis. Radiology. 1979 Oct;133(1):17–21. doi: 10.1148/133.1.17. [DOI] [PubMed] [Google Scholar]
  4. Danner P. K., McFarland D. R., Felson B. Massive pulmonary gangrene. Am J Roentgenol Radium Ther Nucl Med. 1968 Jul;103(3):548–554. doi: 10.2214/ajr.103.3.548. [DOI] [PubMed] [Google Scholar]
  5. Gefter W. B., Weingrad T. R., Epstein D. M., Ochs R. H., Miller W. T. "Semi-invasive" pulmonary aspergillosis: a new look at the spectrum of aspergillus infections of the lung. Radiology. 1981 Aug;140(2):313–321. doi: 10.1148/radiology.140.2.7255704. [DOI] [PubMed] [Google Scholar]
  6. Gutman E., Pongdee O., Park Y. S. Massive pulmonary gangrene. Radiology. 1973 May;107(2):293–294. doi: 10.1148/107.2.293. [DOI] [PubMed] [Google Scholar]
  7. Humphreys D. R. Spontaneous Lobectomy. Br Med J. 1945 Aug 11;2(4414):185–186. doi: 10.1136/bmj.2.4414.185-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Janoff A., Sandhaus R. A., Hospelhorn V. D., Rosenberg R. Digestion of lung proteins by human leukocyte granules in vitro. Proc Soc Exp Biol Med. 1972 Jun;140(2):516–519. doi: 10.3181/00379727-140-36493. [DOI] [PubMed] [Google Scholar]
  9. Khan F. A., Rehman M., Marcus P., Azueta V. Pulmonary gangrene occurring as a complication of pulmonary tuberculosis. Chest. 1980 Jan;77(1):76–80. doi: 10.1378/chest.77.1.76. [DOI] [PubMed] [Google Scholar]
  10. Knight L., Fraser R. G., Robson H. G. Massive pulmonary gangrene: a severe complication of Klebsiella pneumonia. Can Med Assoc J. 1975 Jan 25;112(2):196–198. [PMC free article] [PubMed] [Google Scholar]
  11. Liu P. V. Extracellular toxins of Pseudomonas aeruginosa. J Infect Dis. 1974 Nov;130 (Suppl)(0):S94–S99. doi: 10.1093/infdis/130.supplement.s94. [DOI] [PubMed] [Google Scholar]
  12. Liu P. V. The roles of various fractions of Pseudomonas aeruginosa in its pathogenesis. II. Effects of lecithinase and protease. J Infect Dis. 1966 Feb;116(1):112–116. doi: 10.1093/infdis/116.1.112. [DOI] [PubMed] [Google Scholar]
  13. Murray J. F., Mills J. Pulmonary infectious complications of human immunodeficiency virus infection. Part I. Am Rev Respir Dis. 1990 May;141(5 Pt 1):1356–1372. doi: 10.1164/ajrccm/141.5_Pt_1.1356. [DOI] [PubMed] [Google Scholar]
  14. PESLE G. D., MONOD O. Bronchiectasis due to asperigilloma. Dis Chest. 1954 Feb;25(2):172–183. doi: 10.1378/chest.25.2.172. [DOI] [PubMed] [Google Scholar]
  15. Reich J., Renzetti A. D., Jr Pulmonary phycomycosis. Report of a case of bronchocutaneous fistula formation and pulmonary arterial mycothrombosis. Am Rev Respir Dis. 1970 Dec;102(6):959–964. doi: 10.1164/arrd.1970.102.6.959. [DOI] [PubMed] [Google Scholar]
  16. Slevin M. L., Knowles G. K., Phillips M. J., Stansfeld A. G., Lister T. A. The air crescent sign of invasive pulmonary aspergillosis in acute leukaemia. Thorax. 1982 Jul;37(7):554–555. doi: 10.1136/thx.37.7.554. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. THOMAS J. H., BREWSTER O. M. Friedländer pneumonia with massive necrosis of lung. Br Med J. 1952 Oct 11;2(4788):817–818. doi: 10.1136/bmj.2.4788.817. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Westcott J. L., Cole S. R. Traction bronchiectasis in end-stage pulmonary fibrosis. Radiology. 1986 Dec;161(3):665–669. doi: 10.1148/radiology.161.3.3786716. [DOI] [PubMed] [Google Scholar]

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