Presentation
Patient with prolonged fever and signs of chest infection, difficulty breathing.
Patient Data
Collapse/consolidation of the left lower lobe, which shows multiple scattered areas of low attenuation, representing necrosis. Partial atelectasis of the lingular segment is seen. There is a large pleural effusion. No evidence of enhancing pleura to suggest empyema. No evidence of cavitation.
Incidental azygos fissure on the right. No consolidation, masses or cavitary lesions in the right lung.
No pathologically enlarged mediastinal and hilar lymph nodes. Normal thymic tissue is present, appropriate for age.
No evidence of pleural thickening or masses. Normal cardiac size and shape with no gross abnormality of the cardiac chambers. No pericardial effusion.
Normal CT appearance of the thoracic aorta and the great vessels. Separate origin of the left vertebral artery.
Case Discussion
Necrotizing pneumonia is a rare complication of bacterial lung infection. It may be either because of the micro-organism's high virulence or a host's predisposing factor. This may result in major complications such as diffuse pulmonary inflammation, septic shock, and or respiratory failure. These complications often make treatment more difficult.
Antibiotics are the first line of treatment for necrotizing pneumonia. Surgical treatment has gained acceptance as an alternative treatment option in patients who are unresponsive to antibiotic therapy and develop parenchymal complications.
Appreciation is extended to Dr Ajay Prashanth Dsouza, Dr Muhammad Anwar, Dr Elham Ahmed Elgabaly, Jukha Shater Ali Ali AL Badawi, and fellow Radiographers / Radiology Nurses, Department of Radiology, Al Jalila Children's Specialty Hospital, Dubai, UAE, for contributing to this case.
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