Author Affiliations: Department of Surgery, UPMC Mercy Hospital, Pittsburgh, Pennsylvania.
A 63-year-old man underwent splenectomy, partial wedge resection of the stomach, distal pancreatectomy, and repair of a small diaphragmatic laceration for non-Hodgkin B-cell lymphoma of the spleen. Pathological analysis revealed negative resection margins. The patient received no postoperative chemotherapy or radiation.
Twelve months following surgery, the patient began to have fatigue, weight loss, recurrent sepsis, chronic pulmonary infections, and intermittent foul-smelling spu-tum. Chest radiography and computed tomography repeatedly revealed left lower lobe infiltrate (Figure 1). Alveolar lavage documented an Escherichia coli pneumonia that failed to improve following multiple courses of antibiotics. Findings on positron emission tomography were normal other than increased uptake in the left lower lobe. Colonoscopy results were unremarkable. Subsequently, a barium enema was completed (Figure 2).
Figure 1. Computed tomographic scan of the chest revealing left lower lobe pneumonia. A indicates anterior; L, left; P, posterior; and R, right.
Figure 2. Abdominal radiograph taken shortly after completion of the barium enema, revealing contrast extravasation into the left lower lobe lung field and stomach. R indicates right.
A. Aspiration pneumonia
B. Colobronchial fistula
C. Recurrent lymphoma
D. Postobstructive pneumonia from lung cancer
Thank you for submitting a comment on this article. It will be reviewed by JAMA Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.