CHEST Guidelines-A-45-Year-Old-Man-With-Acute-Chest-Pain,-Fever,-an

A-45-Year-Old-Man-With-Acute-Chest-Pain,-Fever,-an

Pdf Summary

A 45-year-old Japanese man developed acute chest pain, fever, and dyspnea following a wisdom tooth extraction. Initially, his chest pain emerged two days post-surgery, followed by persistent fever and breathing difficulties two weeks later, prompting a hospital visit. Despite no prior medical anomalies or history of alcohol or smoking, the patient exhibited signs of respiratory distress with a high temperature of 40.5°C, reduced oxygen saturation, and an elevated heart and respiratory rate. A chest radiograph performed revealed reduced right-side lung permeability with a fluid level, indicating a lung abscess caused by anaerobic bacterial infection—specifically a giant lung abscess in this immunocompetent patient without noted structural lung dysfunction or systemic immunodeficiency.<br /><br />The causative pathogens, detected via pus analysis, included known oral bacteria, indicating a likely correlation to the recent tooth extraction. This case highlights the risk of severe lung abscess attributable to oral contents aspiration post-dental procedures like tooth extraction. In managing the abscess, aggressive treatment involving chest tube drainage and antibiotic therapy, such as sulbactam/ampicillin and clindamycin, was vital due to bacterial aggressiveness though the patient gradually recovered.<br /><br />The discussion emphasizes heightened awareness for severe lung infections post-tooth extraction, even in patients without traditional risk factors, and endorses prompt diagnostic and therapeutic interventions like percutaneous drainage under ultrasound guidance to mitigate complications. Although no identifiable pathogens were found in blood cultures, dynamic chest CT scans and bronchoscopy confirmed the abscess's bacterial source and progression. The patient’s recovery showcases the necessity of immediate treatment following the emergence of respiratory symptoms post-dental surgery, ensuring comprehensive care regardless of preceding routine dental hygiene and antibiotic prophylaxis.

Keywords

lung abscess

tooth extraction

oral bacteria

anaerobic infection

chest pain

respiratory distress

antibiotic therapy

percutaneous drainage

immunocompetent

dental procedures