RESUMEN
Invasive pulmonary aspergillosis (IPA) is a common infection in neutropenic patients and is associated with high mortality. Aspergillus ustus is a species that has only rarely been implicated in human disease. All reported cases of IPA due to A. ustus have been fatal. Here, we describe a case of invasive pulmonary A. ustus infection successfully treated with lung resection and voriconazole. A 43-year-old man with acute myeloid leukemia underwent two courses of chemotherapy and experienced prolonged neutropenia. Treatment with amphotericin B was given for persistent fever. While he was receiving amphotericin B, a progressive opacity developed in the upper right lobe. Lung tissue obtained through pulmonary wedge resection for histology showed a mold with septate hyphae, consistent with IPA due to Aspergillus. A. ustus was grown in culture. The patient was then treated with voriconazole and remained in remission of the mold infection in spite of additional chemotherapy and a leukemic relapse. In summary, this report describes the successful treatment of invasive pulmonary A. ustus infection by lung resection and antifungal treatment with voriconazole in a neutropenic patient.
Asunto(s)
Antifúngicos/uso terapéutico , Aspergilosis , Aspergillus/efectos de los fármacos , Enfermedades Pulmonares Fúngicas , Neumonectomía/estadística & datos numéricos , Pirimidinas/uso terapéutico , Triazoles/uso terapéutico , Adulto , Aspergilosis/tratamiento farmacológico , Aspergilosis/microbiología , Aspergilosis/cirugía , Humanos , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/microbiología , Enfermedades Pulmonares Fúngicas/cirugía , Masculino , Resultado del Tratamiento , VoriconazolRESUMEN
OBJECTIVE: Invasive pulmonary aspergillosis is frequent in neutropenic patients. Usually localized in the beginning, the disease spreads and mortality is high despite antifungal treatment. The role of early adjuvant surgery is not clear. Surgery may help to confirm fungal disease, may control fungal disease locally and may prevent systemic spreading. This study examines effects of early resection on survival and dissemination in a rat model of localized invasive pulmonary aspergillosis. METHODS: Forty persistently neutropenic male albino rats were challenged with standardized conidial aspergillus inoculum injected into peripheral lung tissue of the right upper lobe under direct vision. Animals were divided into four groups. Twenty animals were treated with amphotericin B at 1 mg/kg per day beginning 48 h after inoculation, 20 animals were left untreated. In each group half the animals underwent early resection of localized invasive aspergillosis by lobectomy. Animals were checked daily and mortality was recorded up to 28 days after which surviving animals were sacrificed. RESULTS: Significantly higher survival was observed in resected animals in the non-Am B groups (survival: 10 +/- 19% without early resection and 50 +/- 32% with early resection; P = 0.044). However, early resection did not lead to improved survival in animals treated with amphotericin B (survival 70 +/- 29% without early resection and 50 +/- 32% with early resection; P = 0.316). CONCLUSIONS: In this rat model of localized invasive pulmonary aspergillosis effects of early resection on survival could be demonstrated only in animals not receiving amphotericin B treatment.
Asunto(s)
Aspergilosis/cirugía , Enfermedades Pulmonares Fúngicas/cirugía , Anfotericina B/uso terapéutico , Animales , Antifúngicos/uso terapéutico , Aspergilosis/complicaciones , Aspergilosis/tratamiento farmacológico , Terapia Combinada , Modelos Animales de Enfermedad , Enfermedades Pulmonares Fúngicas/complicaciones , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Masculino , Neutropenia/complicaciones , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/cirugía , Ratas , Ratas Sprague-Dawley , Tasa de SupervivenciaRESUMEN
Invasive pulmonary aspergillosis is a major cause of morbidity and mortality in neutropenic patients. Microbiological and serological tests are of limited value. The diagnosis should be considered in neutropenic patients with fever not responding to antibiotics, and typical findings on thoracic computed tomography scan. Whenever possible, diagnosis should be confirmed by tissue examination. Newer techniques, such as polymerase chain reaction may change the current diagnostic approach. Therapeutic strategies consist of prophylaxis in risk groups and the early application of antifungal agents in suspected or probable disease. Amphotericin B as desoxycholate or lipid formulation is the current standard medication in invasive infection, although it has major side effects. Its role is challenged by the new azole derivates, such as itraconazole and voriconazole, and the new echinocandins. Additional therapies with cytokines, such as granulocyte macrophage colony stimulating factor and interferon-gamma, and with granulocyte transfusions are under evaluation. In selected cases lung resection is of proven diagnostic and therapeutic value. This paper analyses the current understanding of the pathogenesis and epidemiology of invasive aspergillosis and reviews the actual diagnostic and therapeutic strategies for invasive pulmonary aspergillosis in neutropenic patients.
Asunto(s)
Antifúngicos/uso terapéutico , Aspergilosis/diagnóstico , Aspergilosis/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Neutropenia/inmunología , Anfotericina B/uso terapéutico , Aspergilosis/inmunología , Azoles/uso terapéutico , Broncoscopía , Citocinas/uso terapéutico , Diagnóstico por Imagen , Humanos , Enfermedades Pulmonares Fúngicas/inmunología , Neumonectomía , Pruebas Serológicas , Tomografía Computarizada por Rayos XRESUMEN
Even though complete resection is regarded as the only curative treatment for nonsmall cell lung cancer (NSCLC), >50% of resected patients die from a recurrence or a second primary tumour of the lung within 5 yrs. It remains unclear, whether follow-up in these patients is cost-effective and whether it can improve the outcome due to early detection of recurrent tumour. The benefit of regular follow-up in a consecutive series of 563 patients, who had undergone potentially curative resection for NSCLC at the University Hospital, was analysed. The follow-up consisted of clinical visits and chest radiography according to a standard protocol for up to 10 yrs. Survival rates were estimated using the Kaplan-Meier analysis method and the cost-effectiveness of the follow-up programme was assessed. A total of 23 patients (6.4% of the group with lobectomy) underwent further operation with curative intent for a second pulmonary malignancy. The regular follow-up over a 10-yr period provided the chance for a second curative treatment to 3.8% of all patients. The calculated costs per life-yr gained were 90,000 Swiss Francs. The cost-effectiveness of the follow-up protocol was far above those of comparable large-scale surveillance programmes. Based on these data, the intensity and duration of the follow-up was reduced.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Continuidad de la Atención al Paciente/normas , Costos de la Atención en Salud , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/cirugía , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/economía , Intervalos de Confianza , Análisis Costo-Beneficio , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Esperanza de Vida , Neoplasias Pulmonares/economía , Masculino , Persona de Mediana Edad , Análisis Multivariante , Recurrencia Local de Neoplasia/economía , Neumonectomía/métodos , Neumonectomía/mortalidad , Análisis de Regresión , Reoperación , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Suiza , Factores de TiempoRESUMEN
INTRODUCTION: Invasive pulmonary aspergillosis carries a high mortality in neutropenic patients. Descriptive reports have shown early surgery to be feasible with acceptably low morbidity. The possible benefit of surgery has not been investigated in comparative studies. MATERIALS AND METHODS: In a retrospective cohort study encompassing a 15-year period, 54 (8%) of 697 consecutive patients with severe hematological disease required treatment for localized invasive pulmonary aspergillosis. Patients treated by antifungal drugs (medical group, n = 24) were compared to patients treated with additional early lung resection (surgical group, n = 30). Outcomes analysed were fungal progression and survival. RESULTS: Fungal progression at six months was 17% (95% CI 3-31) in the surgical group and 52% (95% CI 34-73) in the medical group (P = 0.005). Survival at six months was 70% (95% CI 53-87) in surgically and 42% (95% CI 24-62) in medically treated patients (P = 0.009). Adjusting for differences in WHO performance score (worse in the medical group) and duration of neutropenia (longer in the surgical group) in a multivariate analysis, a difference in relative risk of death (0.26; 95% CI 0.08-0.88; P = 0.03) remained in favor of surgery. CONCLUSION: In this retrospective study surgical intervention to treat invasive pulmonary fungal disease appeared to have a beneficial effect on the impact of disease control and survival. Differences in baseline characteristics of the two patient groups calls for cautious interpretation. A prospective randomized trial seems warranted.
Asunto(s)
Aspergilosis/cirugía , Enfermedades Pulmonares Fúngicas/cirugía , Neumonectomía/estadística & datos numéricos , Adolescente , Adulto , Anciano , Antifúngicos/administración & dosificación , Aspergilosis/tratamiento farmacológico , Aspergilosis/mortalidad , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/mortalidad , Masculino , Persona de Mediana Edad , Neutropenia/complicaciones , Neutropenia/microbiología , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Assessment of quality of care in adult cardiac surgery is only adequate if done in a risk adjusted manner. Over the last 10 years a number of risk stratification scores have been established internationally. This prospective study compares three important and widespread scores, the Parsonnet-, the Higgins-, and the French-score. Correlation between incremental risk groups and mortality was best achieved with French-score. The score was reliable due to easily available risk factors and a small number of risk groups.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/normas , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Humanos , Estudios Prospectivos , Análisis de Regresión , Medición de RiesgoRESUMEN
BACKGROUND AND AIM OF THE STUDY: The study aim was to determine the incidence and clinical significance of late cardiac conduction defects (CD) after aortic valve replacement (AVR). METHODS: An analysis was made of 100 consecutive cases after AVR in a prospective outpatient evaluation program. RESULTS: The perioperative (30-day) mortality rate was 5%, and incidence of perioperative pacemaker implantation 3%. Among patients, 19% had CDs before surgery; a normal ECG was present during all periods in 45% of patients. The most frequent perioperative CD was left anterior hemiblock (LAHB; n = 8), and the most frequent late CD was left bundle branch block (LBBB; n = 8). Overall, 13.7% of operative survivors with normal preoperative and perioperative ECGs developed late CDs; one patient (1%) required pacemaker implantation 82 months after AVR. A further three patients (3%) had worsening of pre-existent CDs. Late CDs occurred over a wide time range (3 to 102 months) after surgery. CONCLUSION: There is an important incidence of CDs that occur late after AVR, even if the perioperative ECGs are normal; however, a need for late pacemaker implantation is rare. As CDs may occur at any time after surgery, regular follow up with precise evaluation of ECGs is called for.
Asunto(s)
Válvula Aórtica/cirugía , Bloqueo Cardíaco/etiología , Implantación de Prótesis de Válvulas Cardíacas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios ProspectivosAsunto(s)
Aspergilosis/complicaciones , Aspergilosis/cirugía , Trasplante de Médula Ósea , Enfermedades Pulmonares Fúngicas/complicaciones , Enfermedades Pulmonares Fúngicas/cirugía , Neutropenia/complicaciones , Adolescente , Femenino , Humanos , Inducción de Remisión , Sobrevivientes , Factores de TiempoRESUMEN
BACKGROUND: The influence of age on early and late outcome after surgical resection of bronchogenic carcinoma is unknown. In an attempt to clarify this issue, we reviewed the outcome of 212 consecutive patients with primary lung cancer who had surgical treatment for bronchogenic carcinoma. METHODS: Ninety-two patients were younger than 50 years (group 1), and 120 patients were older than 70 years of age (group 2). Squamous cell carcinoma and adenocarcinoma were the most common histologic types in both groups. According to the new international staging classification, a similar proportion of stage I, II, and III were observed in both groups. RESULTS: Only the rate of pneumonectomy was significantly higher in younger patients (41% versus 22%, p = 0.002). The overall operative mortality rate in group 1 was 2.2% and 2.6% after pneumonectomy. In group 2 the overall mortality rate was 2.5% and 3.8% after pneumonectomy. Advanced age did not affect operative mortality. The adjusted (tumor-related) survival rate at 5 years was 56% in group 1 and 53% in group 2 (p = 0.93). The adjusted survival rate for patients with stage I was 61% in group 1 and 65% in group 2 (p = 0.21), and for stage IIIa 39% in group 1 and 48% in group 2 (p = 0.43). The adjusted 5-year survival rate was 56% in group 1 and 59% in group 2 for squamous cell carcinoma (p = 0.53) and 49% in group 1 and 42% in group 2 for adenocarcinoma (p = 0.76). CONCLUSIONS: Perioperative risk and midterm survival were similar in younger and older patients after surgical resection of bronchogenic carcinoma. We believe that this result is because surgical candidates constitute already a highly selected group of patients. From these data it is not possible to conclude that biologic behavior of lung cancer is more aggressive in younger patients.
Asunto(s)
Carcinoma Broncogénico/cirugía , Neoplasias Pulmonares/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Carcinoma Broncogénico/mortalidad , Carcinoma Broncogénico/patología , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Complicaciones Posoperatorias/epidemiología , Tasa de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Morbidity and mortality of early resection of invasive pulmonary fungal disease in neutropenic patients are still considered prohibitive for surgical treatment. METHODS: We retrospectively analyzed results of 28 (16 men, 12 women; mean age, 38.9 years) consecutive neutropenic hematologic patients who had lung resections for suspicion of invasive pulmonary fungal disease. RESULTS: We did 28 lung resections (19 lobectomies, one bilobectomy, eight single or multiple wedge resections including three video-assisted wedge resections). The disease was proved histologically in 22 (78.6%) cases. Intraoperative difficulties, such as diffuse oozing or mycotic infiltration, and solid postinflammatory adhesions were encountered in 5 (17.8%) and 6 (21.4%) patients respectively. In one case (3.6%) it lead to a major intraoperative hemorrhage. There were no intraoperative deaths, overall 30-day mortality rate was two of 28 (7.1%), overall 90-day mortality rate was seven of 28 (25%), with one death (3.6%) possibly related to surgery. Minor surgery-related complications were seen in ten (35.7%) cases, major surgery-related complications occurred in three (10.7%) cases. Twelve of 22 patients (54.5%) with proven invasive fungal infection are currently alive (mean follow-up, 32.3 months). CONCLUSIONS: Surgery-related complications and mortality are acceptable for this high risk group of patients. Resection should be carried out early for diagnostic as well as therapeutic reasons.
Asunto(s)
Enfermedades Pulmonares Fúngicas/cirugía , Neutropenia/cirugía , Infecciones Oportunistas/cirugía , Neumonectomía , Adolescente , Adulto , Anciano , Niño , Femenino , Estudios de Seguimiento , Humanos , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/mortalidad , Complicaciones Intraoperatorias/cirugía , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/mortalidad , Masculino , Persona de Mediana Edad , Neutropenia/diagnóstico , Neutropenia/mortalidad , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/mortalidad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Tasa de SupervivenciaRESUMEN
STUDY OBJECTIVE: Microdialysis measurements of human cardiac metabolism during and after cardiac operations have not been published up to now. The goal of this study was to evaluate feasibility of the method in a clinical setting and to interpret first results. PATIENTS AND METHODS: In 5 patients microdialysis measurements were made in regular intervals during aortocoronary bypass surgery. Analysis of dialysate was done by high performance liquid chromatography or enzymatic fluorometry. In the last 2 patients measurements were also taken during the postoperative course up to the time of extubation. RESULTS: During aortic cross clamping a mean 7-fold rise of the radical scavenger glutathione was observed (range 0.9-15.4; p = 0.06). During reperfusion the glucose/lactate(Glc/Lac)-rate rose from 0.4 to 3.1 (p = 0.02). Concentrations of ascorbic acid, cysteine and uric acid remained neutral or showed no regular changes. In the 2 patients who were also observed postoperatively, lactate rose significantly at 190 min and 340 min postoperatively (decrease in Glc/Lac-ratio from 2.5 to 0.4 and 2.0 to 0.4 respectively). CONCLUSIONS: Microdialytic measurements of metabolic parameters can be performed on the human heart in a clinical setting. So far no complications have been observed and the microdialysis probe can be installed in such a fashion, that it can be easily removed transcutaneously during the postoperative course. Substances that are important in ischemia and reperfusion can be measured and their concentrations show changes that are not just artefacts. Postoperatively, metabolic alterations may be observed in the myocardial septum that are not recordable with conventional techniques (i.e., pressure measurements, cardiac output, ECG).
Asunto(s)
Puente de Arteria Coronaria , Metabolismo Energético/fisiología , Complicaciones Intraoperatorias/fisiopatología , Microdiálisis/instrumentación , Monitoreo Intraoperatorio/instrumentación , Miocardio/metabolismo , Complicaciones Posoperatorias/fisiopatología , Anciano , Glucemia/metabolismo , Estudios de Factibilidad , Femenino , Glutatión/metabolismo , Humanos , Ácido Láctico/sangre , Masculino , Persona de Mediana Edad , Daño por Reperfusión Miocárdica/fisiopatologíaRESUMEN
An aggressive mediastinal fibrosis was found in a 42-year-old female, suffering from dysphagia, stabbing pain in the chest, and an unclear weight loss. In this case, the rare combination of esophageal involvement, bronchial narrowing, and pulmonary artery obstruction could easily be demonstrated with a barium study and a helical CT examination including three-dimensional reconstructions.
Asunto(s)
Procesamiento de Imagen Asistido por Computador , Enfermedades del Mediastino/diagnóstico por imagen , Arteria Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Constricción Patológica/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Fibrosis/diagnóstico por imagen , Humanos , Hipertensión Pulmonar/diagnóstico por imagenRESUMEN
BACKGROUND: Pulmonary complications often occur in patients with leukemia and severe aplastic anemia. Particularly in patients having undergone bone marrow transplantation, respiratory diseases account for a significant number of deaths. In a retrospective study, we evaluated 41 patients with leukemia and severe aplastic anemia who were operated on consecutively from 1980 to 1995. METHODS: Fourteen open lung biopsies, four video-assisted lung biopsies, and 24 lung resections were performed in 24 male and 17 female patients. Mean age was 32.2 years. RESULTS: Eleven (27%) early deaths occurred (30-day mortality): ten in patients after lung biopsy (56%) and one after lung resection (4%) (p < 0.001). Perioperative morbidity relating to pulmonary disease or operation included 10 (24.4%) cases of prolonged (> 24 hours) postoperative mechanical ventilation and two (4.8%) cases of bleeding or hematoma. In one (2.4%) patient a slowly developing, contained bronchial stump insufficiency appeared after lobectomy, which was successfully operated on 3 weeks later. CONCLUSION: We conclude that resection of localized pulmonary lesions, be it for diagnostic or therapeutic (or combined) purposes, can be carried out with low morbidity and mortality in patients with leukemia and severe aplastic anemia. However, early mortality is high after open or thoracoscopic lung biopsies in patients with acute-onset diffuse pulmonary disease, and little therapeutic benefit is realized in these cases.
Asunto(s)
Anemia Aplásica/complicaciones , Leucemia/complicaciones , Enfermedades Pulmonares/cirugía , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
In this retrospective investigation we carried out a thorough physical examination, ventilation/perfusion scintigraphy, echocardiography and lung function test in 19 of all 21 long-term survivors consecutively operated on for massive pulmonary embolism between 1968 and 1992. Two patients refused these investigations but were both asymptomatic. The mean follow-up was 8.4 years and 12 (57%) of the patients were in NYHA I and 6 (29%) in NYHA II. The three patients in NYHA III (there were none in class IV) underwent right heart catheterization and pulmonary angiography additionally. Our findings suggest that, generally, the results of scintigraphy, echocardiography, lung function tests and physical examination correspond to the subjective status expressed as NYHA (dyspnea) class, when evaluated in combination. However, in classes III and IV other causes of dyspnea apart from residual pulmonary vascular obstruction can be found. These may also occur in combination. We observed severe chronic obstructive lung disease, hemidiaphragmatic paralysis, obesity, pulmonary hypertension of unknown origin, atrial septal defect (ASD) and neurologic residual deficit with depressive state. Thus, in evaluating long-term results of pulmonary embolectomy with regard to vascular desobliteration, NYHA classification does not seem to be reliable for classes III and IV.
Asunto(s)
Embolia Pulmonar/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Disnea/clasificación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Función Respiratoria , Estudios Retrospectivos , Sobrevivientes , Resultado del TratamientoRESUMEN
Since the early days of pacemaker development electromagnetic interference (EMI) has always been a major concern and challenge to engineers, producers and physicians. The latter has to be aware of adverse effects of certain electric medical devices used near or on a patient carrying a pacemaker. Although highly sophisticated circuits and filters inside modern pacemakers can reject most EMI, concerns still remain and normal pacemaker function can be affected. EMI can be triggered by a variety of medical devices such as electrocautery, magnetic resonance imaging, diathermy, cardioversion and defibrillation, therapeutic radiation and lithotripsy. This article addresses the possible effects of electrocautery and the precautions that should be taken in case such a device has to be used on a patient with a pacemaker.
Asunto(s)
Electrocoagulación , Campos Electromagnéticos , Marcapaso Artificial , Contraindicaciones , Electrocoagulación/instrumentación , Humanos , Factores de RiesgoRESUMEN
We report on our first experiences with an access in video-assisted thoracoscopic surgery (VATS) which to the best of our knowledge has not yet been reported. One of the main problems in VATS is the absence of palpation which evidently plays an important role in tumor surgery. In three cases we therefore performed dorsolateral 8 cm incisions just beneath the scapula and resected a corresponding length on 6th or 7th rib to be able to insert one hand into the thorax. No rib-spreader was used in either case, the idea being that a small costotomy would be less painful and traumatic than a standard posterolateral thoracotomy. Visualization of the operative field was obtained by inserting a camera through the 9th intercostal space, one or two additional small incisions were made for the other instruments.
Asunto(s)
Costillas/cirugía , Toracoscopía/métodos , Grabación en Video , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirugía , Anciano , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirugía , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Palpación , ToracoscopiosRESUMEN
We report on a 57-year-old male presenting with cough and chest pain as well as a chronic infiltrate in the right posterior basel segment. Antibiotic treatment had been unsuccessful, CT-guided needle-biopsy and bronchoscopy had failed to forward reliable results. Thus, videothoracoscopic biopsy was performed and histologic diagnosis of a low-grade non-Hodgkin's lymphoma was obtained. The tumor was left in situ and single-agent chemotherapy was initiated for reasons which are discussed. Up to now localized pulmonary lymphomas were mainly resected in the course of an exploratory thoracotomy because the disease often could not be diagnosed with certainty previously. It is discussed whether surgical resection is still the best choice or other treatment modalities should be preferred.