Presentation
Two weeks of chest pain, breathlessness and productive cough. Smoker. History of IV drug abuse.
Patient Data
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Right upper zone consolidation with cavitating features and gas-fluid level.
No abnormalities in left lung. Cardiac silhouette normal.
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Inflammatory mass with cavitation in the right upper lobe and right middle lobe. Smaller discrete abscesses in the superior right lower lobe.
Tree-in-bud appearance consistent with infective bronchitis.
No lymph node enlargement.
Unremarkable abdominal viscera.
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Reduction in fluid component but widespread residual consolidation in right lung.
Small volume of pleural fluid in right upper and mid-zones.
Case Discussion
This pulmonary abscess seemed to make some progress with intravenous and oral antibiotic therapy.
Although a number of potential causes were investigated (through multiple blood cultures, sputum cultures, bronchalveolar lavage washouts and cytology, TB, HIV tests, cardiac echo) no infective source was isolated.