Acute right lung abscess

Case contributed by Dr Derek Smith

Presentation

Two weeks of chest pain, breathlessness and productive cough. Smoker. History of IV drug abuse.

Patient Data

Age: 40
Gender: Male

Admission film

Modality: X-ray

Right upper zone consolidation with cavitating features and gas-fluid level.

No abnormalities in left lung. Cardiac silhouette normal.

Modality: CT

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.

Follow up during antibiotic course

Modality: X-ray

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.

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Case Information

rID: 34806
Case created: 9th Mar 2015
Last edited: 1st Sep 2015
System: Chest
Tag: abscess
Inclusion in quiz mode: Included

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