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Streptococcus anginosus InfectionsCrossing Tissue Planes in S anginosus Infections: Crossing Tissue Planes

Bernie Y. Sunwoo, MBBS; Wallace T. Miller, Jr, MD
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From the Department of Medicine, Division of Pulmonary, Allergy, Critical Care Medicine, Division of Sleep Medicine (Dr Sunwoo) and Department of Radiology (Dr Miller), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA.

CORRESPONDENCE TO: Bernie Y. Sunwoo, MBBS, Department of Medicine, Division of Pulmonary, Allergy, Critical Care Medicine, Division of Sleep Medicine, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 1st Floor, W Pavilion, 3400 Civic Center Blvd, Philadelphia, PA 19104; e-mail: bernie.sunwoo@uphs.upenn.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):e121-e125. doi:10.1378/chest.13-2791
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Streptococcus anginosus has long been recognized to cause invasive pyogenic infections. This holds true for thoracic infections where S anginosus has a propensity for abscess and empyema formation. Early diagnosis is important given the significant morbidity and mortality associated with thoracic S anginosus infections. Yet, distinguishing thoracic S anginosus clinically is difficult. We present three cases of thoracic S anginosus that demonstrated radiographic extension across tissue planes, including the interlobar fissure, diaphragm, and chest wall. Few infectious etiologies are known to cross tissue planes. Accordingly, we propose S anginosus be considered among the differential diagnosis of potential infectious etiologies causing radiographic extension across tissue planes.

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