Presentation
Cough and loss of weight over five weeks.
Patient Data
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Large cavitating right upper lobe mass with cavitation. Left lung is clear. Normal cardiomediastinal contour.
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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.
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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 favor infection over malignancy. Follow-up demonstrated marked reduction in size, also in keeping with infection rather than malignancy.
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