1995 OPEN FORUM Abstracts
HEPATIZATION OF A LUNG LOBE AS A CAUSE OF PERSISTENT COUGH.
Ali Emad MD. Shiraz University of Medical Sciences, Shiraz, Iran.
BACKGROUND: Hepatization of a lung lobe is rare. l report a case of hepatization of the right lower lobe resulting in severe paroxysmal cough. CASE SUMMARY: A 28-year-old man who sustained a gunshot injury 8 years ago with resultant perforated right hemidiaphragm and lacerated liver now complained of paroxysmal cough. Shortly after these were repaired, the patient complained of gradually worsening dyspnea on exertion. A chest radiograph (CXR) revealed elevation of the diaphragm and pleural effusion on the right. Surgery revealed herniation of the liver through the diaphragm, which was repaired. Three weeks after surgery, patient developed a chronic cough that persisted and, now, has become paroxysmal. Each CXR has shown elevated diaphragm that was believed due to sluggish movement of the diaphragm. Right-basilar breath sounds were decreased. In addition to the elevated diaphragm, CXR showed narrowing of the right middle and lower lobes. Bronchography supported the diagnosis of hepatization of these lobes. Thoracotomy revealed that the lower lobe was attached to the diaphragm. Both middle and lower lobes were resected and the diagnosis was confirmed by histology. Six months after this operation, the patient is well. DISCUSSION: Hepatization means a transformation of a lesion into a liver-like mass during a process of pneumonitis, which is transient. The hepatized lung tissue cannot participated in gas exchange. This condition is rare but may be found following pneumonia, lung transplantation, migration of Ascaris larvae, poisoning, and trauma. Symptoms are variable and include persistent and paroxysmal cough, hemoptysis, repeated pneumonia, hypoxia and chest pain. The diagnosis is made by biopsy. Persistent hepatization of a lung lobe should be considered as a cause of an unresolved and undiagnosed cough following diaphragmatic trauma.