Cavitating pneumonia

Case contributed by Dr Henry Knipe

Presentation

Cough and loss of weight over five weeks.

Patient Data

Age: 60 years
Gender: Male
X-ray

Large cavitating right upper lobe mass with cavitation. Left lung is clear. Normal cardiomediastinal contour.

CT

Dense consolidation almost replacing the entire right upper lobe, with cavitation seen anterosuperiorly. The horizontal fissure is not well seen, but there appears to be minimal involvement of the right middle lobe. Minor bibasal atelectasis. Right hilar and mediastinal lymph node enlargement. Right oblique fissure thickening.

X-ray

Four weeks later post antibiotic treatment

There is been a significant decrease in the size of the cavitating right upper lobe mass, this is consistent with a resolving area of infection.

 

The patient proceeded to bronchoalveolar lavage, with specimens sent for MC&S and cytology. 

Culture:

MICROSCOPY / GRAM STAIN

  • Pus Cells +
  • Squamous Epithelial Cells Not Detected
  • Gram positive cocci +

CULTURE

Streptococcus agalactiae (group B) ++

Cytology:

MICROSCOPIC DESCRIPTION: The smears are composed of acute inflammatory exudate with occasional scattered bronchial cells in the background. No fungal elements demonstrated on Grocott stain. No malignant cells are identified.

DIAGNOSIS: Bronchial Washings: Acute inflammation; negative for malignancy.

Case Discussion

This is a very large cavitating pneumonia with a subacute presentation. The key differential for this is malignancy, however, the degree of consolidation is very large and cavitation small and this would favour infection over malignancy. Follow-up demonstrated marked reduction in size, also in keeping with infection rather than malignancy. 

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Case information

rID: 45998
Case created: 16th Jun 2016
Last edited: 28th Jun 2016
System: Chest
Inclusion in quiz mode: Included

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