CTICasesActinomyces Tracheal Necrosis
Imaging findings
CT demonstrates marked circumferential thickening of the mid and distal trachea with necrotic debris and material filling the tracheal lumen in a poorly controlled type 1 diabetic. Bronchoscopy confirmed complete tracheal mucosal necrosis over approximately 5 cm, with no normal tracheal tissue remaining. A follow-up CT four days later shows further thickening and luminal narrowing.
Key takeaways
Actinomyces is a gram-positive anaerobic bacterium normally found in the oral cavity that classically causes indolent pulmonary actinomycosis with sulfur granules and fistula formation. Rarely, in immunocompromised or diabetic patients, it can cause aggressive tracheal infection with extensive necrosis, a pattern distinct from its usual chronic, fibrosis-predominant presentation. Early recognition and long-course antibiotics are essential.
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