Cavitating pneumonia - lingular segments

Case contributed by Dr James Sheldon

Presentation

Cough. Fever.

Patient Data

Age: 90 years
Gender: Male
Modality: X-ray

There is consolidation within the left lower lobe. Within this region there are at least two well defined lucencies which are concerning for cavitation.

There is a calcified curvilinear structure within the right middle lobe of uncertain significance. Right upper lobe opacification could be due to fibrotic change although a degree of upper lobe collapse is not excluded.

Retrocardiac midline lucencies are consistent with a hiatus hernia.

Small pleural effusion of the left.

The heart size is within normal limits.

Conclusion:

Left lower lobe consolidation with lucencies that may represent cavitation in this setting. Further evaluation with CT suggested.

Modality: CT

 

Consolidation within the left upper lobe with multiple areas of cavitation containing air fluid levels and diffuse background emphysematous changes with bulla formation. There is a large bulla in the right middle lobe extending to the right diaphragm.

A 7mm nodule in the anterior left upper lobe and  3 mm nodule  in the right lower lobe.

Small left-sided pleural effusion and mediastinal lymphadenopathy. Large hiatus hernia.

Conclusion:

Cavitating left lingula consolidation. Aetiology includes aspiration (given the large hiatus hernia) or TB. An underlying cavitating mass is considered less likely.

 

Case Discussion

Cavitation with the lung has a broad differential with infection and malignancy making up the majority of cases.

Large bulla are not infrequently seen in emphysema. They can mimic pneumothorax or a cavitating lung mass. Comparison with previous studies to confirm stability is usually the most helpful next step.

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Case Information

rID: 34386
Case created: 18th Feb 2015
Last edited: 8th Dec 2015
System: Chest
Inclusion in quiz mode: Included

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