Presentation
Chest pain and dyspnea. CT pulmonary angiography is requested to rule out pulmonary embolism. Lab tests revealed high D-dimer level.
Patient Data
A large pulmonary cavity is seen involving the apical and posterior segments of the right lower lobe. It shows dependent fluid content with an air-fluid level. It shows a mild thick wall connected to subsegmental divisions of the bronchial tree. It is surrounded by subsegmental atelectasis of basal parts of the right lower lobe. Patent pulmonary arterial tree excluding pulmonary embolism.
Cleared cavity contents after 2 weeks of antibiotic therapy, with residual post-pneumonic pneumatocele.
Case Discussion
The patient presented with chest pain and dyspnea with a high D-dimer level and was suspected to have a pulmonary embolism. CT pulmonary angiography was done that shows normal patency of the pulmonary arterial tree. A cavity with air-fluid level is identified at the right lower lobe, that responded to antibiotic therapy with cleared content on follow-up, in keeping with pulmonary abscess.
Differential considerations in pulmonary cavities include pulmonary abscess, necrotic malignancy, cavitating pneumonia and granulomatosis with polyangiitis.
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