Cavitating pneumonia - lingular segments

Case contributed by Dr James Sheldon

Presentation

Cough. Fever.

Patient Data

Age: 90 years
Gender: Male

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.

 

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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