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Canadian Respiratory Journal
Volume 21, Issue 4, Pages 239-245
http://dx.doi.org/10.1155/2014/864159
Review

Management of Necrotizing Pneumonia and Pulmonary Gangrene: A Case Series and Review of the Literature

Neela Chatha,1 Dalilah Fortin,2,3,4 and Karen J Bosma1,3,5

1Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
2Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
3Divisions of Critical Care, London Health Sciences Centre, London, Ontario, Canada
4Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
5Division of Respirology, London Health Sciences Centre, London, Ontario, Canada

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Necrotizing pneumonia is an uncommon but severe complication of bacterial pneumonia, associated with high morbidity and mortality. The availability of current data regarding the management of necrotizing pneumonia is limited to case reports and small retrospective observational cohort studies. Consequently, appropriate management for these patients remains unclear.

OBJECTIVE: To describe five cases and review the available literature to help guide management of necrotizing pneumonia.

METHODS: Cases involving five adults with respiratory failure due to necrotizing pneumonia admitted to a tertiary care centre and infected with Streptococcus pneumoniae (n=3), Klebsiella pneumoniae (n=1) and methicillin-resistant Staphylococcus aureus (n=1) were reviewed. All available literature was reviewed and encompassed case reports and retrospective reviews dating from 1975 to the present.

RESULTS: All five patients received aggressive medical management and consultation by thoracic surgery. Three patients underwent surgical procedures to debride necrotic lung parenchyma. Two of the five patients died in hospital.

CONCLUSIONS: Necrotizing pneumonia often leads to pulmonary gangrene. Computed tomography of the thorax with contrast is recommended to evaluate the pulmonary vascular supply. Further study is necessary to determine whether surgical intervention, in the absence of pulmonary gangrene, results in better outcomes.